A 30-year global study led by University of Queensland researchers has found rates of childbirth by caesarean section are rising and exceeding safe levels in many developing countries.
UQ’s Life Course Centre investigated rates of caesarean delivery in 74 low and middle-income countries, reporting increasing risks to the lives of mothers and babies. Life Course Centre PhD candidate Md. Mehedi Hasan said that caesarean delivery rates had increased over time in most of the countries, some quite remarkably. “In more than one-quarter of countries, caesarean rates exceeded the optimal rate of 15 per cent,” Mr Hasan said. “The highest rates were in the Dominican Republic at 58.9 per cent, Egypt at 55.5 per cent and Turkey at 48.3 per cent.
Caesarean delivery rates above 20 per cent place mothers and babies at greater risk of surgery-related complications for current and subsequent pregnancies. At the same time, caesarean rates below five per cent also negatively affect maternal health. The study found caesarean rates below five per cent in more than one-quarter of low and middle-income countries, with the lowest rates in Madagascar and Chad at 1.5 per cent and Niger at 1.6 per cent.
“Controlling caesarean delivery at the optimal level is not an easy task,” Mr Hasan said. “It is challenging and requires a multi-faceted collaborative approach. What is crucial for controlling the overuse of caesarean delivery is the use of the service in a meaningful way when medically required.” With data from nearly 1.5 million live births, the study called for improved training of health professionals, health education for women, and labour management guidelines to achieve optimal caesarean section rates. Life Course Centre Chief Investigator Associate Professor Abdullah Mamun said to reach the UN 2030 Sustainable Development Goals on reproductive, maternal, newborn and child health, all births should be delivered at facilities where demand-based emergency obstetric care service is available.
“In developing countries, obstetric complications during childbirth are responsible for 70 per cent of maternal deaths,” Dr Mamun said. “Ensuring women have their babies in facilities with demand-based use of caesarean section can save lives and positively impact maternal and child health.” The report also found that increasing caesarean delivery rates were highest among the richest women living in urban centres. “The highest rates of caesarean delivery were found in high-income and urban women, rather than low-income and rural women,” Dr Mamun said. “These inequalities are widening alarmingly over time.”
The study was a collaboration between Life Course Centre researchers at UQ’s Institute for Social Science Research, Mr Mehedi Hasan, Tahmina Begum, Dr Yaqoot Fatima and Dr Abdullah Mamun, and Associate Professor Ricardo J Soares Magalhaes of UQ’s Spatial Epidemiology Laboratory and Professor Saifuddin Ahmed of the Johns Hopkins Bloomberg School of Public Health. The research is published in the British Journal of Obstetrics and Gynaecology (DOI: 10.1111/1471-0528.16744).