Cesarean section trends in Barrero, Dominican Republic: a community-level analysis of rates, risk factors, and patient motivations.

Introduction: This study, conducted in the Dominican community of Barrero, aimed to quantify rates of Cesarean sections (C-section) and explore their associations with age, education level, nationality, health insurance type, and delivery location. Additionally, this study aimed to uncover women's motivations for undergoing vaginal or C-section delivery for each birth. Methods: This cross-sectional study interviewed 121 women ages 18-50 years living in Barrero, Dominican Republic via house-to-house sampling in February 2025. Using a 39-question survey, information on all pregnancies for children 12 years and under was collected, yielding data for 236 pregnancies. Quantitative data was analyzed using generalized estimating equations to account for the correlation inherent to mothers providing responses on more than one pregnancy. Qualitative data was analyzed with thematic analysis using an inductive approach. Results: Of pregnancies measured, 71.2% were C-sections; 61.4% of these were described as planned (vs. emergent). Estimated C-section rate for the community of Barrero was 71.5%. Women were more likely to undergo Csection if they were older at the time of delivery ( Discussion: In Barrero, DR, C-section deliveries were found to have multifactorial associations. Csections were more common among women with any formal education, older maternal age, Dominican nationality, those who had private insurance, and those who delivered in private hospitals. Further studies must evaluate the influence healthcare institutions and providers have on women's decisions regarding C-section and interventions are needed to address this disparity in care.