C-section use doubled in India between 2005 and 2015: Lancet

Alicia Farmer
October 14, 2018

"The large increases in C-section use - mostly in richer settings for nonmedical purposes - are concerning because of the associated risks for women and children", said Dr. Marleen Temmerman, lead author of three studies published October 11 in The Lancet.

C-section is a type of major surgery, which carries risks that require careful consideration.

New research shows that in just 15 years, the worldwide rate of c-section births has almost doubled.

Cesarean delivery, a surgical procedure in which a baby is born via incisions in the uterus and abdomen, now accounts for 21 percent of all births around the world, according to the new findings, compared to just 12 percent 18 years ago.

"The large increases in C-section use - mostly in richer settings for non-medical purposes - are concerning because of the associated risks for women and children", said Marleen Temmerman, an expert from Aga Khan University in Kenya and Ghent University in Belgium who co-led the research.

Analysing global trends of birth, the research reveals that the rate of c-sections has nearly doubled since the turn of the century, rising from 12 percent of all births in 2000 to 21 percent in 2015 - almost doubling.

Researchers said 60 per cent of countries were overusing the procedure and 25 per cent underusing it, suggesting wide disparities in how the clinical recommendations are being followed.

C-section is a life-saving intervention for women and newborns when complications occur, such as bleeding, foetal distress, hypertensive disease, and babies in abnormal position.

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"It is crucial that women who need Caesarean sections are able to access this potentially life-saving procedure", the World Health Organization advises, adding that it is equally important that unnecessary procedures be avoided "so women and their babies are not put at risk".

However, it is estimated that between 10% and 15% of all the cesarean section births are necessary for medical reasons. However, improvements have been slow across sub-Saharan Africa (around 2% per year), where C-section use has remained low (increasing from 3% to 4.1% of births in West and Central Africa, and from 4.6% to 6.2% in Eastern and Southern Africa). The increase in the number of such operations, doctors stress, is associated with many factors, particularly income and education women.

Dr Jane Sandall, professor of social science and women's health at King's College London and a study author, said there were a variety of reasons for women increasingly opting for surgery. The majority of these procedures were found to be performed for low-risk deliveries and for women who had previously had C-sections (which can make a subsequent vaginal delivery dangerous).

Part of this trend is being driven by income and access to health facilities.

In a comment accompanying the study, Gerard Visser of the University Medical Centre in the Netherlands, called the rise in C-sections 'alarming'.

"Although The Lancet Series says that women's demand is not a substantial driver of the current problem of overuse, efforts to reduce caesareans must, nevertheless, strongly respect women's rights to choose the circumstances of birth".

"Greater understanding of this is important to help inform decision making by families, physicians, and policy makers". Annually in France, cesarean section is 20% if delivery.

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