Abstract
To examine temporal trends in caesarean delivery rates in southern Asia and sub-Saharan Africa, by country and wealth quintile. Cross-sectional data were extracted from the results of 80 Demographic and Health Surveys conducted in 26 countries in southern Asia or sub-Saharan Africa. Caesarean delivery rates were evaluated - as percentages of the deliveries that ended in live births - for each wealth quintile in each survey. The annual rates recorded for each country were then compared to see if they had increased over time. Caesarean delivery rates had risen over time in all but 6 study countries but were consistently found to be lower than 5% in 18 of the countries and 10% or less in the other eight countries. Among the poorest 20% of the population, caesarean sections accounted for less than 1% and less than 2% of deliveries in 12 and 21 of the study countries, respectively. In each of 11 countries, the caesarean delivery rate in the poorest 40% of the population remained under 1%. In Chad, Ethiopia, Guinea, Madagascar, Mali, Mozambique, Niger and Nigeria, the rate remained under 1% in the poorest 80%. Compared with the 22 African study countries, the four study countries in southern Asia experienced a much greater rise in their caesarean delivery rates over time. However, the rates recorded among the poorest quintile in each of these countries consistently fell below 2%. Caesarean delivery rates among large sections of the population in sub-Saharan Africa are very low, probably because of poor access to such surgery.
Highlights
Caesarean sections, when adequately indicated, can prevent poor obstetric outcomes and be life-saving procedures for both the mother and the fetus.[1]
The data that we used came from the countries in southern Asia or sub-Saharan Africa that were included in the “Countdown to 2015” initiative,[17] only data from the 26 countries where there had been at least two Demographic and Health Surveys (DHSs) were analysed
The total sample consisted of 686 789 deliveries – each of which had ended in a live birth – that had occurred between 1985 and 2011
Summary
Caesarean sections, when adequately indicated, can prevent poor obstetric outcomes and be life-saving procedures for both the mother and the fetus.[1] at a time when the caesarean delivery rate – as a percentage of live births – has been rising globally,[1] there is growing concern about unnecessary caesarean sections.[2] Unnecessary caesarean sections can increase the risk of maternal morbidity, neonatal death and neonatal admission to an intensive care unit.[2] At the same time, there is concern that – in low-income countries in general and among the poorer sections of the populations in such countries in particular – caesarean sections are not always accessible, even when they are clearly indicated.[3]. Values between 5% and 15% of live births have been suggested, the basis on which these thresholds have been proposed is not clear.[4] Some historical studies indicate that low maternal mortalities can be achieved when the caesarean delivery rate is far below 15% of live births. In the Netherlands, for example, maternal mortality had fallen below 20 deaths per 100 000 live births by 1950, when caesarean sections were associated with less than 2% of live births.[5,6] The results of some ecological studies indicate that no further reductions in mortality occur when caesarean delivery rates increase above 10%, and that rates above 15% may be associated with additional mortality.[7,8] The World Health Organization (WHO) has suggested that a caesarean delivery rate of 15% should be taken as a threshold that should not be exceeded – rather than a target to be achieved.[4]
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