AFP :
Worldwide Caesarean section use has nearly doubled in two decades and has reached “epidemic” proportions in some countries, doctors warned Friday, highlighting a huge gap in childbirth care between rich and poor mothers.
They said millions of women each year may be putting themselves and their babies at unnecessary risk by undergoing C-sections at rates “that have virtually nothing to do with evidence-based medicine”. In 2015, the most recent year for which complete data is available, doctors performed 29.7 million C-sections worldwide — 21 percent of all births. This was up from 16 million in 2000, or 12 percent of all births, according to research published in The Lancet. It is estimated that the operation-a vital surgical procedure when complications occur during birth-is necessary 10-15 percent of the time. But the research found wildly varying country rates of C-section use, often according to economic status: in at least 15 countries more than 40 percent births are performed using the practice, often on wealthier women in private facilities. In Brazil, Egypt and Turkey, more than half of all births are done via C-section. The Dominican Republic has the highest rate of any nation, with 58.1 percent of all babies delivered using the procedure. But in close to a
quarter of nations surveyed, C-section use is significantly lower than average. Authors pointed out that while the procedure is generally over-used in many middle- and high-income settings, women in low-income situations often lack necessarily access to what can be a life-saving procedure. “We would not expect such differences between countries, between women by socioeconomic status or between provinces/states within countries based on obstetric need,” Ties Boerma, professor of public health at the University of Manitoba, Winnipeg, and a lead author on the study, told AFP.
Jane Sandall, professor of social science and women’s health at King’s College London and a study author, told AFP that there were a variety of reasons women were increasingly opting for surgery.
These include “a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend a vaginal delivery, as well as medico-legal issues.” Doctors are often tempted to organise C-sections to ease the flow of patients through a maternity clinic, and medical professionals are generally less vulnerable to legal action if they choose an operation over a natural birth.
Sandall also said there were often “financial incentives for both doctor and hospital” to perform the procedure.
The study warned that in many settings young doctors were becoming “experts” in C-section while losing confidence in their abilities when it comes to natural birth. It also identified an emerging gap between wealthy and poorer regions within the same country. In China, C-section rates diverged from 4 percent to 62 percent; in India the range was 7-49 percent.
Worldwide Caesarean section use has nearly doubled in two decades and has reached “epidemic” proportions in some countries, doctors warned Friday, highlighting a huge gap in childbirth care between rich and poor mothers.
They said millions of women each year may be putting themselves and their babies at unnecessary risk by undergoing C-sections at rates “that have virtually nothing to do with evidence-based medicine”. In 2015, the most recent year for which complete data is available, doctors performed 29.7 million C-sections worldwide — 21 percent of all births. This was up from 16 million in 2000, or 12 percent of all births, according to research published in The Lancet. It is estimated that the operation-a vital surgical procedure when complications occur during birth-is necessary 10-15 percent of the time. But the research found wildly varying country rates of C-section use, often according to economic status: in at least 15 countries more than 40 percent births are performed using the practice, often on wealthier women in private facilities. In Brazil, Egypt and Turkey, more than half of all births are done via C-section. The Dominican Republic has the highest rate of any nation, with 58.1 percent of all babies delivered using the procedure. But in close to a
quarter of nations surveyed, C-section use is significantly lower than average. Authors pointed out that while the procedure is generally over-used in many middle- and high-income settings, women in low-income situations often lack necessarily access to what can be a life-saving procedure. “We would not expect such differences between countries, between women by socioeconomic status or between provinces/states within countries based on obstetric need,” Ties Boerma, professor of public health at the University of Manitoba, Winnipeg, and a lead author on the study, told AFP.
Jane Sandall, professor of social science and women’s health at King’s College London and a study author, told AFP that there were a variety of reasons women were increasingly opting for surgery.
These include “a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend a vaginal delivery, as well as medico-legal issues.” Doctors are often tempted to organise C-sections to ease the flow of patients through a maternity clinic, and medical professionals are generally less vulnerable to legal action if they choose an operation over a natural birth.
Sandall also said there were often “financial incentives for both doctor and hospital” to perform the procedure.
The study warned that in many settings young doctors were becoming “experts” in C-section while losing confidence in their abilities when it comes to natural birth. It also identified an emerging gap between wealthy and poorer regions within the same country. In China, C-section rates diverged from 4 percent to 62 percent; in India the range was 7-49 percent.
