Archives of Gynecology and Obstetrics

, Volume 287, Issue 4, pp 633–639 | Cite as

Cesarean section rate differences by migration indicators

  • Anita J. GagnonEmail author
  • Andrea Van Hulst
  • Lisa Merry
  • Anne George
  • Jean-François Saucier
  • Elizabeth Stanger
  • Olive Wahoush
  • Donna E. Stewart
Maternal-Fetal Medicine



To answer the question: are there differences in cesarean section rates among childbearing women in Canada according to selected migration indicators?


Secondary analyses of 3,500 low-risk women who had given birth between January 2003 and April 2004 in one of ten hospitals in the major Canadian migrant-receiving cities (Montreal, Toronto, Vancouver) were conducted. Women were categorized as non-refugee immigrant, asylum seeker, refugee, or Canadian-born and by source country world region. Stratified analyses were performed.


Cesarean section rates differed by migration status for women from two source regions: South East and Central Asia (non-refugee immigrants 26.0 %, asylum seekers 28.6 %, refugees 56.7 %, p = 0.001) and Latin America (non-refugee immigrants 37.7 %, asylum seekers 25.6 %, refugees 10.5 %, p = 0.05). Of these, low-risk refugee women who had migrated to Canada from South East and Central Asia experienced excess cesarean sections, while refugees from Latin America experienced fewer, compared to Canadian-born (25.4 %, 95 % CI 23.8–27.3). Cesarean section rates of African women were consistently high (31–33 %) irrespective of their migration status but were not statistically different from Canadian-born women. Although it did not reach statistical significance, risk for cesarean sections also differed by time since migration (≤2 years 29.8 %, >2 years 47.2 %).


Migration status, source region, and time since migration are informative migration indicators for cesarean section risk.


Cesarean section Emigration and immigration Women Postpartum health care needs 



The NORMAPERS study was funded by the Canadian Institutes of Health Services and Policy Research and of Gender and Health Research (CIHR # 95355), le Réseau de recherche en santé des populations, and Immigration et métropoles. We would also like to acknowledge Drs. Geoffrey Dougherty, Robert W. Platt, and Jacqueline Oxman-Martinez with their assistance in the conception, design, and implementation of the NORMAPERS study.

Conflict of interest

We declare that we have no conflict of interest. We do not have a financial relationship with the organization that sponsored the research and we have had full control of all primary data and agree to allow the Journal to review this data if requested.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Anita J. Gagnon
    • 1
    • 2
    Email author
  • Andrea Van Hulst
    • 4
  • Lisa Merry
    • 3
  • Anne George
    • 5
  • Jean-François Saucier
    • 6
  • Elizabeth Stanger
    • 7
  • Olive Wahoush
    • 8
  • Donna E. Stewart
    • 9
    • 10
  1. 1.Ingram School of Nursing and Department of Obstetrics and GynecologyMcGill UniversityMontrealCanada
  2. 2.Women’s Health MissionMcGill University Health CenterMontrealCanada
  3. 3.Ingram School of NursingMcGill UniversityMontrealCanada
  4. 4.Université de MontréalMontrealCanada
  5. 5.University of British ColumbiaPrince GeorgeCanada
  6. 6.Centre Hospitalier universitaire de mère enfant, L’Hôpital Sainte-JustineMontrealCanada
  7. 7.Vancouver Coastal HealthVancouverCanada
  8. 8.McMaster UniversityHamiltonCanada
  9. 9.University Health NetworkTorontoCanada
  10. 10.University of TorontoTorontoCanada

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