Date of Award

January 2021

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Rafael Peréz-Escamilla

Second Advisor

Gabriela Buccini


Background. Poverty, racism, and other sources of oppression threaten children’s nurturing environments and associated early childhood development (ECD). Women of Color and their children are disproportionately exposed to risk factors for poor ECD in Brazil. There is a growing body of evidence supporting the claim that unnecessary cesarean section (CS) is associated with poor maternal health outcomes and ECD delays. There is an existing gap in the literature on risk factors, including obstetric factors, of poor ECD among children of Women of Color in Brazil.

Objective. The objective of this thesis was to investigate factors, including obstetric characteristics of CS delivery and preterm birth, associated with risk of overall ECD delay among children of low-income Women of Color in Federal District, Brazil.

Methods. This is a cross-sectional study using data collected from 2017 to 2018 at primary health units in Federal District, Brazil. Women with children under the age of 2 were surveyed on factors related to ECD. The primary outcome was risk of overall ECD delay. Data analysis consisted of descriptive statistics, bivariate analysis, and a hierarchical multivariate analysis.

Results. The final sample included 930 children of which 17.3% were at risk of overall ECD delay. The following variables were associated with risk of overall ECD delay: household food insecurity, mother-headed household, maternal employment, CS delivery, late preterm gestational age, early term gestational age, inadequate feeding, pacifier use, and child age greater than six months.

Conclusions. CS is associated with risk of ECD delay among children of Women of Color in Federal District, Brazil. Children born as late preterm or early term neonates, many of whom are born by CS, also have increased risk of ECD delay. This information can inform health promotion practices supporting obstetric practice that promote positive ECD outcomes.


This thesis is restricted to Yale network users only. It will be made publicly available on 06/01/2023