Frecuencia de la cesárea en Andalucía: relación con factores sociales, clínicos y de los servicios sanitarios (2007-2009)

background: increasing trend and geographical variations in the use of caesarean section suggest the influence of non-clinical factors. the objective was to describe the use of caesarean section in the andalusian region in spain by exploring the role of social, clinical, and health services variables. methods: a cross-sectional study was carried out using vital statistics. it involves all births occurred in andalusia during the period of 2007-2009. the dependent variable was the use of caesarean section and the set of covariates were classified into three groups: those with a clinical meaning, those related to the health services organization, and those with a social significance. multivariate logistic regressions were used. results: in the data set of 293,558 births, the prevalence of caesarean delivery was 24.8%. the multivariate analysis highlights the labour complications as the clinical variable with the highest odds ratio (or=19.36). regarding the health services variables, the odds of experiencing a caesarean delivery were 55% higher on weekdays than on weekends. cádiz was the province with the highest or for caesarean section (comparison between cádiz and almería: or=1,21) where the ratio between births in public and private hospitals was 3.7. the frequency of caesarean section was 34% higher in women with third level education than those with no education. conclusions: labour complication is the most influential variable for caesarean section. caesarean birth rate is above the accepted standards for all social classes and increases with educational level. inter-provincial differences reflect different patterns with regard to the use of private medicine.