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Since 1985, the World Health Organisation (WHO) and the global health community have considered an ideal rate for Caesarean Sections (CS) to be between 10% and 15% of all live births. [1] When medically required, the procedure can save both a mother her child’s life. However, little evidence exists indicating CS confers any benefit for woman or child if conducted without indication.
In fact, like any surgery, the procedure could negatively impact the health of the woman and the child, as well as any future pregnancies resulting in haemorrhage, infection and death. In addition, the procedure may cause resource constraints and financial implications for national health systems. Therefore, the risks are higher than any benefits when considering unnecessary caesarean sections.
Despite this, in many middle and high-income countries, there has been increased adoption of unnecessary and excessive practices. For example, in China, more than a third of women now have a caesarean section, with the rate exceeding 60% in many cities. [2] In Brazil, rates of CS are amongst the highest globally, up to 85% in some private hospitals, while one in five births in the UK are now caesareans. [3]
A number of campaigns and new policies have been put in place in an attempt to control when such a procedure is carried out. In Brazil, a new set of rules were introduced in 2015, aimed at curbing such high rates of CS; requiring doctors to justify indications for caesarean, alongside documentation of the course of the pregnancy. [4]
It is not entirely understood what factors influence the choice for CS, however a number of small studies have investigated possible reasons. Some reasons include the increasing dependency on technology, increased feeling of control for the patient, and ease of a scheduled birth for the doctor and patient. A recent review investigated women’s perceptions on the procedure, and found little evidence for patients as the main driving factor behind CS, potentially indicating a more physician-centered problem.
A full understanding of the driving factors (in addition to analysing the success of existing policies in place) could advise evidence-based policy on the topic in the future. The London Women’s Health team aim to conduct a systematic review of the literature to understand the main factors that are contributing to the rising trend across a number of middle income countries, and where possible, some policy recommendations in an attempt to curb this dangerous trend.
Ranya Mulchandani is an MSc student of Control of Infectious Diseases at the London School of Hygiene and Tropical Medicine and is particularly interested in women’s health and infectious disease epidemiology. Radhika Thakrar is an MBBS/BSc student at Imperial College London with a particular interest in women’s health. Harvinder Power is an MBBS/BSc student at Imperial College London with a particular interest in Global Health and Surgery.
References:
[1] WHO Statement on Cesarean Section Rates, 2015
[2] Li et al. Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014. JAMA 2017 (317),69-76
[3] Caesarean sections UK Parliament, 2002
[4] http://www.bbc.co.uk/news/world-latin-america-33421376