IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v289y2021ics0277953621007383.html
   My bibliography  Save this article

State-level structural sexism and cesarean sections in the United States

Author

Listed:
  • Nagle, Amanda
  • Samari, Goleen

Abstract

The United States (U.S.) has one of the highest cesarean rates in the world yet little research considers structural factors, like racism and sexism, associated with the higher than recommended cesarean rate. New research operationalizes and quantifies structural sexism across U.S. states, which allows for consideration of how social norms and values around women and their bodies relate to the overmedicalization of birth through cesarean sections. We obtained restricted natality data for 2018 from the U.S. National Center for Health Statistics. In 2018, among people 15–49 years, 987,187 births fit the criteria for low-risk of cesarean section. Structural sexism scores were derived from 6 elements covering economic, political, cultural, and physical arenas that were totaled and standardized to create an aggregate index for each state and DC (scores range from −1.06 to 1.4). Using multivariable logistic and multilevel mixed effects logistic regression models, we examined the associations between structural sexism and low-risk cesarean section for all fifty states and the District of Columbia, controlling for relevant confounders. We found that structural sexism in 2018 was highest in historically religious mountain states and the South. Nationally, the low-risk cesarean rate was 25.1%. Multilevel models show that people living in states with higher structural sexism scores were more likely to have a cesarean section (OR = 1.22, 95% CI: 1.07–1.39). Structural sexism is related to low-risk cesarean rates in U.S., providing evidence that social ideas and norms about women and their bodies are related to overmedicalization of birth. Health policymakers, providers and scholars should pay attention to structural drivers, including structural sexism, as a factor that affects overmedicalization of birth and subsequent health outcomes for pregnant people and their infants.

Suggested Citation

  • Nagle, Amanda & Samari, Goleen, 2021. "State-level structural sexism and cesarean sections in the United States," Social Science & Medicine, Elsevier, vol. 289(C).
  • Handle: RePEc:eee:socmed:v:289:y:2021:i:c:s0277953621007383
    DOI: 10.1016/j.socscimed.2021.114406
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953621007383
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.socscimed.2021.114406?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Leone, Tiziana & Padmadas, Sabu S. & Matthews, Zoë, 2008. "Community factors affecting rising caesarean section rates in developing countries: An analysis of six countries," Social Science & Medicine, Elsevier, vol. 67(8), pages 1236-1246, October.
    2. Lobel, Marci & DeLuca, Robyn Stein, 2007. "Psychosocial sequelae of cesarean delivery: Review and analysis of their causes and implications," Social Science & Medicine, Elsevier, vol. 64(11), pages 2272-2284, June.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Everett, Bethany G. & Philbin, Morgan M. & Homan, Patricia, 2024. "Structural heteropatriarchy and maternal cardiovascular morbidities," Social Science & Medicine, Elsevier, vol. 351(S1).
    2. Homan, Patricia, 2024. "Health consequences of structural sexism: Conceptual foundations, empirical evidence and priorities for future research," Social Science & Medicine, Elsevier, vol. 351(S1).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Agampodi, Thilini Chanchala & Agampodi, Suneth Buddhika & Glozier, Nicholas & Siribaddana, Sisira, 2015. "Measurement of social capital in relation to health in low and middle income countries (LMIC): A systematic review," Social Science & Medicine, Elsevier, vol. 128(C), pages 95-104.
    2. Grant, Darren, 2022. "The “Quiet Revolution” and the cesarean section in the United States," Economics & Human Biology, Elsevier, vol. 47(C).
    3. Kruk, Margaret E. & Rockers, Peter C. & Mbaruku, Godfrey & Paczkowski, Magdalena M. & Galea, Sandro, 2010. "Community and health system factors associated with facility delivery in rural Tanzania: A multilevel analysis," Health Policy, Elsevier, vol. 97(2-3), pages 209-216, October.
    4. Annika Karlström & Regina Engström‐Olofsson & Astrid Nystedt & Mats Sjöling & Ingegerd Hildingsson, 2010. "Women’s postoperative experiences before and after the introduction of spinal opioids in anaesthesia for caesarean section," Journal of Clinical Nursing, John Wiley & Sons, vol. 19(9‐10), pages 1326-1334, May.
    5. Melaku Desta & Haile Amha & Keralem Anteneh Bishaw & Fentahun Adane & Moges Agazhe Assemie & Getiye Dejenu Kibret & Nigus Bililign Yimer, 2020. "Prevalence and predictors of uterine rupture among Ethiopian women: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(11), pages 1-19, November.
    6. Doan Thi Thuy Duong & Colin Binns & Andy Lee & Yun Zhao & Ngoc Minh Pham & Dinh Thi Phuong Hoa & Bui Thi Thu Ha, 2022. "Intention to Exclusively Breastfeed Is Associated with Lower Rates of Cesarean Section for Nonmedical Reasons in a Cohort of Mothers in Vietnam," IJERPH, MDPI, vol. 19(2), pages 1-11, January.
    7. Tonei, Valentina, 2019. "Mother’s mental health after childbirth: Does the delivery method matter?," Journal of Health Economics, Elsevier, vol. 63(C), pages 182-196.
    8. Rosenthal, Lisa & Lobel, Marci, 2011. "Explaining racial disparities in adverse birth outcomes: Unique sources of stress for Black American women," Social Science & Medicine, Elsevier, vol. 72(6), pages 977-983, March.
    9. Tully, Kristin P. & Ball, Helen L., 2013. "Misrecognition of need: Women's experiences of and explanations for undergoing cesarean delivery," Social Science & Medicine, Elsevier, vol. 85(C), pages 103-111.
    10. Signe Svallfors, 2024. "Giving Birth While Facing Death: Cesarean Sections and Community Violence in Latin America," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 43(2), pages 1-22, April.
    11. Grytten, Jostein & Skau, Irene & Sørensen, Rune, 2017. "The impact of the mass media on obstetricians’ behavior in Norway," Health Policy, Elsevier, vol. 121(9), pages 986-993.
    12. Myriam de Loenzien & Clémence Schantz & Bich Ngoc Luu & Alexandre Dumont, 2019. "Magnitude and correlates of caesarean section in urban and rural areas: A multivariate study in Vietnam," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-14, July.
    13. Saman Nazir & Cynthia Cready, 2020. "The C-Section Epidemic in Pakistan," PIDE-Working Papers 2020:176, Pakistan Institute of Development Economics.
    14. Cristina Teixeira & Susana Silva & Milton Severo & Henrique Barros, 2015. "Socioeconomic Position Early in Adolescence and Mode of Delivery Later in Life: Findings from a Portuguese Birth Cohort," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-16, March.
    15. Grytten, Jostein & Skau, Irene & Sørensen, Rune, 2011. "Do expert patients get better treatment than others? Agency discrimination and statistical discrimination in obstetrics," Journal of Health Economics, Elsevier, vol. 30(1), pages 163-180, January.
    16. Shen, Menghan & Li, Linyan, 2020. "Differences in Cesarean section rates by fetal sex among Chinese women in the United States: Does Chinese culture play a role?," Economics & Human Biology, Elsevier, vol. 36(C).
    17. Dipti Govil & Sanjay Kumar Mohanty & Pralip Kumar Narzary, 2020. "Catastrophic household expenditure on caesarean deliveries in India," Journal of Population Research, Springer, vol. 37(2), pages 139-159, June.
    18. Head, Sara K. & Yount, Kathryn M. & Sibley, Lynn M., 2011. "Delays in recognition of and Care-seeking response to prolonged labor in Bangladesh," Social Science & Medicine, Elsevier, vol. 72(7), pages 1157-1168, April.
    19. Ahcène Zehnati & Marwân-al-Qays Bousmah & Mohammad Abu-Zaineh, 2021. "Public–private differentials in health care delivery: the case of cesarean deliveries in Algeria," International Journal of Health Economics and Management, Springer, vol. 21(3), pages 367-385, September.
    20. Rajesh Kamath & Helmut Brand & Nisha Nayak & Vani Lakshmi & Reena Verma & Prajwal Salins, 2023. "District-Level Patterns of Health Insurance Coverage and Out-of-Pocket Expenditure on Caesarean Section Deliveries in Public Health Facilities in India," Sustainability, MDPI, vol. 15(5), pages 1-17, March.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:289:y:2021:i:c:s0277953621007383. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.