June 17, 2021

World Health Organisation (WHO) says caesarean section use continues to rise globally, now accounting for more than one in five (21 per cent ) of all childbirths.

WHO, in a statement on Wednesday, stated that the rising rates suggested increasing numbers of medically unnecessary and potentially harmful procedures.

The UN health agency stated that worldwide caesarean section rates had risen from around seven per cent in 1990 to 21 per cent today, and are projected to continue increasing over this current decade.

According to new research from WHO, this number is set to continue increasing over the coming decade, with nearly a third (29 per cent) of all births likely to take place by caesarean section by 2030.

While a caesarean section can be an essential and lifesaving surgery, it can put women and babies at unnecessary risk of short- and long-term health problems if performed when there is not medical need, the research finds.

The statement quoted Dr Ian Askew, Director of WHO’s Department of Sexual and Reproductive Health and Research, as saying, “Caesarean sections are absolutely critical to save lives.

“Caesarean sections are absolutely critical to save lives in situations where vaginal deliveries would pose risks, so all health systems must ensure timely access for all women when needed.

“But not all the caesarean sections carried out at the moment are needed for medical reasons; unnecessary surgical procedures can be harmful, both for a woman and her baby.”

The report stated that caesarean sections could be essential in situations such as prolonged or obstructed labour, fetal distress, or because the baby is presenting in an abnormal position.

However, it stated that as with all surgeries, they could have risks.

“These include the potential for heavy bleeding or infection, slower recovery times after childbirth, delays in establishing breastfeeding and skin-to-skin contact, and increased likelihood of complications in future pregnancies.

“Caesarean section rates rising globally, though unequally, with increases projected to continue.

“There are significant discrepancies in a woman’s access to caesarean section, depending on where in the world she lives.

“In the least developed countries, about eight per cent of women gave birth by caesarean section with only five per cent in sub-Saharan Africa, indicating a concerning lack of access to this lifesaving surgery.’’

It stated that quality, women-centred were needed to address high use of caesarean section

“Causes of high caesarean section usage vary widely between and within countries; drivers include health sector policies and financing, cultural norms, perceptions and practices, rates of preterm births, and quality of healthcare.

“Rather than recommending specific target rates, WHO underscores the importance of focusing on each woman’s unique needs in pregnancy and childbirth.’’

The statement further quoted Dr. Ana Betran, Medical Officer at WHO, as saying “it’s important for all women to be able to talk to healthcare providers.

“It is important for all women to be able to talk to healthcare providers and be part of the decision making on their birth, receiving adequate information including the risks and benefits.

“Emotional support is a critical aspect of quality care throughout pregnancy and childbirth.”

WHO, therefore, recommended some non-clinical actions that can reduce medically unnecessary use of caesarean sections, within the overall context of high quality and respectful care:

WHO recommends educational interventions that engage women actively in planning for their birth such as childbirth preparation workshops, relaxation programmes and psychosocial support where desired, for those with fear of pain or anxiety.

“Implementation of such initiatives should include ongoing monitoring and evaluation.

“Use of evidence-based clinical guidelines, performing regular audits of caesarean section practices in health facilities, and providing timely feedback to health professionals about the findings.’’

It further recommended that requirement for a second medical opinion for a caesarean section decision in settings where this is possible.

“For the sole purpose of reducing caesarean sections, some interventions have been piloted by some countries but require more rigorous research.

“A collaborative midwifery-obstetrician model of care, for which care is provided primarily by midwives, with 24-hour back-up from a dedicated obstetrician

“Financial strategies that equalise the fees charged for vaginal births and caesarean sections.’’