Joint effect of education and age at childbirth on the risk of caesarean delivery: findings from Germany 2008-2015

Objectives: This article aims at assessing the joint effect of maternal age and education on the risk of having a caesarean delivery. As high maternal education is often associated with lower caesarean-birth rates, but high-educated women tend to postpone motherhood, these effects may offset each other in traditional analyses. Study design: Secondary analysis of the data from the German Family Panel pairfam. Methods: The interview-based data refer to 1020 births between 2008 and 2015. We analyse only reports from mothers and calculate logistic regression models. Results: The caesarean delivery rate differs strongly between education levels, and low educated women are at higher risk of having a caesarean delivery when controlling for parity and age. A positive age gradient is found, indicating a higher risk of caesarean section for older mothers. Without controlling for age, the association of education and caesarean section risk is weaker, i.e., effects of age and education partially level each other out. A model including an interaction term between age and education confirms this result. Conclusions: The risk of having a caesarean delivery does not differ between levels of education when maternal age is not taken into account. Lower maternal education and higher age are both positively associated with the risk of experiencing a caesarean section in Germany. However, as higher educated women tend to have their children later, effects of education and age weigh each other out. Preventive campaigns should target women with lower education and raise women's awareness on the risks associated with late motherhood. (C) 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.