About 40% of all births in Brazil are c-sections, most being elective. Private hospital c-section rates are much higher with some being at 100%. The reason given by Marsden Wagner, MD, a perinatal epidemiologist who works for the World Health is that roughly one quarter of the mothers are from upper or middle class. Many doctors perform c-sections to receive higher payments from the insurance companies and to save time by not allowing women to go through the labor process. Most women do not attend childbirth classes. They receive all of their information from their doctor and tend to go along with their plan for a c-section. In 1998 the Brazilian government instituted procedures to reduce the rate of c-sections.