C-section rate rises globally as costly intervention replaces natural process

Enormous differences in the rate of cesarean-section delivery among countries.


A new data suggests that the global rate of C-section doubled from 2000 to 2015 and now accounts for more than 1 in 5 live births. It enlightens a high rate of a medically unnecessary section and disparities among countries.

The study represents enormous differences in the rate of cesarean-section delivery among different countries. The outcomes suggest that many women undergo unnecessary C-sections in some countries while in other countries those who actually need the procedure don’t have access.

In Brazil, the overall rate is 55%. But, the rate in that country ranges from about 80% (women in the top quintile of household income) to near 20%.

Dr. Fernando Barros, an epidemiologist in Brazil said, “Women have the right” to decide how their babies are delivered, but this cannot compete with the right of the baby to be delivered at full term.”

“These babies run a much higher risk of morbidity and mortality.”

Caluwaertsl said, “At the other extreme is Sierra Leone, where the rate is among the lowest in the world, at 2.2% of deliveries. While working there, I observed cases of mothers who lost babies because of a lack of trained health care providers and midwives who could recognize delivery complications. Women with obstetrical fistula obstructed labor or placenta previa often had to travel 12–24 hours to clinics or hospitals. The outcomes for mothers and babies were often grim.”

Ties Boerma, a professor in the Centre for Global Public Health at the University of Manitoba said, “We were absolutely surprised by the differences among countries. The expected rate of C-section for medical reasons is 10%–15%. A rate lower than this usually results from lack of access to care, but a much higher rate — seen in countries in Latin America, the Caribbean, and the Middle East — also causes for concern.”

“There is an increased risk of maternal and baby morbidity and mortality with C-section — it’s small but you can’t ignore it.”

Boerma said, “We’re replacing a natural process with a costly intervention. There is also an economic aspect that needs to be taken into account.”

According to Barros, “this is a complex, multi-factorial situation. Among patients, “this is a question of money. As people become more educated, have a higher income and pay more for doctors, they have more access to C-section.”

Boerma said, “In countries where the C-section rate could be compared with education level, higher education among mothers was correlated with more C-sections because of higher rates of hospital delivery.”

“But physicians are also pushing up the rates. In some countries, obstetricians are paid more for C-section or may fear litigation after vaginal births.”

“In Brazil, physicians are getting more training in C-section than in vaginal delivery in medical schools.”

Barros said, “They prefer C-section because it is faster than vaginal delivery, and they also feel the pressure of potential litigation. Physicians feel that, if they give a cesarean, they cannot be accused of not providing the best care.”

“In Brazil, the ministry of health and the federal council of medicine are launching a public awareness campaign to make women aware of the advantages of vaginal delivery, following the success of campaigns to promote breastfeeding and vaccination. I am hopeful we will be able to reverse the trend.”

The study is presented in the journal Lancet.


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