The number of births by caesarean section has almost doubled in the world in 15 years, from 12% to 21% between 2000 and 2015, exceeding even 40% in 15 countries. The situation has led gynecologists to question this “epidemic”, as reported in a report published Friday in the British scientific journal The Lancet .
It is estimated that the rate of caesarean section absolutely necessary for medical reasons varies from 10 to 15%. However, 60% of the 169 countries surveyed are above this range, while a quarter of the countries are below, putting the mother and the child at risk, the study that is based on figures from the World Health Organization (WHO) and UNICEF.
In 15 countries, including the Dominican Republic, Brazil, Egypt, Turkey, Venezuela, Chile, Colombia and Iran, more than 40% of births occur by caesarean section.
“The large increase in caesarean sections, mostly in comfortable and unhealthy environments, is problematic because of the associated risks for mother and child,” says study coordinator Marleen Temmermann (Aga Khan University). Kenya and Ghent University in Belgium).
“In cases where complications occur, cesareans save lives, and we need to promote women’s access [to this intervention] in poor areas, but we should not abuse it.”
Disparities are considerable between sub-Saharan Africa (4.1% of Caesareans) and Latin America and the Caribbean, where the rate reached 44.3% in 2015.
In Asia, the use of caesareans increased on average by 6% per year, climbing from 7.2% to 18.1% of births between 2000 and 2015.
In North America (32% of Caesareans in 2015) and Western Europe (26.9%), the increase is approximately 2% per year.
Level of education and income
The Lancet study, based on data collected by WHO and UNICEF, does not explain this staggering increase in caesarean sections in some countries.
However, it notes a link with the level of income and education of women. In Brazil, for example, 54.4% of women who have completed high-level studies deliver by caesarean section versus 19.4% of women with less education.
In low- and middle-income countries, wealthier women are six times more likely to deliver by caesarean section than the poor, and operations are 1.6 times more likely in private clinics.
Several possible reasons
In the article, the World Congress of Gynecology and Obstetrics in Brazil puts forward several hypotheses as to the reasons for this “epidemic”, including a decline in the competence of the medical profession to accompany a potentially difficult childbirth by natural means, the comfort of scheduling day births, and more attractive rates for doctors and clinics in case of caesarean section.
In France, the rate of caesarean section (20.4% in 2016) remains stable since 2010, “which suggests a general attitude tending to limit the achievement of this intervention,” notes the latest perinatal survey published by the Ministry of Health.
Cédric Grouchka, member of the College of the French High Authority of Health, speaks of “downward stabilization” and makes a distinction between “caesareans performed in a hurry, either after a delivery that goes wrong or during work – which correspond to 60% of the total in France – caesareans scheduled for medical reasons (40%) and those programmed for a non-medical reason, at the request of women “, which he estimates to” less than 1% “.
Fear of childbirth
For Jane Sandall of King’s College London, if some women choose a caesarean, it is usually “fear of childbirth, sometimes after a traumatic first experience.” The quality of care and premises, which must preserve the privacy of women and allow the presence of a loved one, is essential in the face of these fears, she believes.
The World Congress of Gynecology and Obstetrics (FIGO) advocates several measures to limit the abuse of caesareans: to apply a single rate for births, by caesarean section or not, to force hospitals to publish their statistics, to better inform women of the risks and improve training in natural birth.
Marie Bram started working for Spruce Tribune in 2017. Marie grew up in a small town in northern Manitoba. But moved to Ontario for university. Before joining Spruce Tribune, Marie briefly worked as a freelance journalist for CBC News. She covers politics and the economy.