Caesarean section (cs) rates in developed countries have grown rapidly over the past few decades, leading to concern among some experts that cs rates of 25-35% might be causing more harm than good to women and driving unnecessary health care expenditures (the US rate is roughly 30%). While it has been known for some time that rates are also high in some Latin American countries, there is a general perception that rates are still low in most developing countries – perhaps even too low. At least that is my perception based on the data I have seen from Sub-Saharan African countries.
I guess that is why it was so shocking for me to learn that rates in many Asian countries are high, potentially as high, as rates seen in Latin America and most developed countries. The results of a multi-country facility-based study of delivery and pregnancy outcomes in Asia has shown that at least a quarter of births delivered in facilities in 9 Asian countries were delivered by Caesarean section – in China nearly one half of births ended in a Caesarean section.
The study was only conducted in facilities, so these should not be taken as national rates. The authors also explored whether or not more intensive births were associated with better or worse outcomes for the mother and baby and found evidence that suggest that if anything these procedures are causing more harm than good (again, these findings should be interpreted cautiously given selection effects due to the facility-based nature of these surveys). But taken together, the overall levels and potential consequences do raise the question of whether cs rates are too high in some developing countries as well?
There are at least three potential explanations as to why rates are so high. First, it might be that women want caesarean sections and are increasingly electing these procedures. The Asia study did not seem to suggest this to be the case as most of the surgeries were done during the intrapartum period with indications. Second, it might be that there has been increased need for the service or new indications for which it is recommended – this again seems a bit unlikely as it is hard to imagine what could possibly explain the rapid increases. Finally, it could be that the physician has a high level of discretionary power over the decision to operate and that due to a number of factors have become more likely to intervene. This seems – at least to me – to be the most likely candidate but of course, I have not seen any good
evidence to support this view.
I really think that studies of this nature point to the urgent need for a better understanding of how women are accessing pre-natal, delivery, and post-natal care – not just in the developing world but everywhere. I am almost 7 months pregnant and am currently trying to develop a plan for my own delivery but end up finding myself frustrated with the lack of evidence that seems to be available to inform my decisions. It is amazing how little we know about a process that has been happening for at least as long as human have been on this earth…Share on Facebook