Date of Award


Degree Type


Degree Name

Doctor of Philosophy


Women of higher socioeconomic status have been observed to have higher rates of cesarean delivery, said to be evidence that many cesarean sections are unnecessary. Previous investigations have been conducted in settings where access to obstetrical services may be dependent on ability to pay, and investigators have often not adjusted differences for maternal age, parity and previous cesarean delivery, factors known to confound the association. Whether women of upper or lower socioeconomic status are at increased risk of cesarean delivery for biological reasons has not been determined.;The purpose of this investigation was to examine the association between cesarean delivery and socioeconomic indicators in a setting with universal health insurance and all obstetrical services. Eligible residents of London, Ontario, giving birth during the study period were invited to participate. Questionnaires were completed by 2383 (78.5 percent) of those eligible during their postpartum stay in hospital. Questionnaire information allowed participants to be classified according to several indicators of socioeconomic status. Additional information was abstracted from consenting participant's hospital charts.;Women of higher socioeconomic status not only did not have higher rates of cesarean delivery, but appeared to have lower rates. The estimated odds ratio of cesarean delivery for women with a university degree compared to women who had not completed high school was 0.37 (0.22, 0.64; 95% C.I.) after adjusting for age, parity, and previous cesarean delivery. Among women defined as "low risk," the estimated odds ratio of cesarean delivery for women with a university degree compared to women who had not completed high school was 0.16 (0.06, 0.43; 95% C.I.) after adjustment for maternal age, parity, maternal height and infant birth weight. Further exploration showed that factors hypothesized to be related to poor growth during childhood and adolescence may be associated with increased odds of a cesarean delivery.;It is likely that the results of the current investigation differ from the results of previous investigations because of the greater control over potentially confounding factors that the study design facilitated. It is recommended that investigators of differences in cesarean section rates adjust for population differences as fully as possible and consider that undetected differences in population characteristics may exist.



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