Huge unmet need for Caesarean sections in developing countries

An estimated 80 000 women in 42 developing countries do not have access to life-saving caesareans sections, according to a study in this week's issue of The Lancet.

Making sure women have timely access to competent hospital care is essential to achieve low levels of maternal mortality. Currently, little is known about the effect of socioeconomic status on access to life-saving obstetric care in hospitals.

To investigate, Carine Ronsmans (London School of Hygiene and Tropical Medicine, UK) and colleagues examined caesarean rates by socioeconomic groups in 42 developing countries in sub-Saharan Africa, south and southeast Asia, and Latin America and the Caribbean. They found that rates of caesareans varied substantially between and within countries. In the poorest countries – mostly in sub-Saharan Africa – large segments of the population have little or no access to caesareans, even among the wealthy. At the other extreme, in seven countries, mostly Latin American, caesareans are far in excess of the suggested maximum threshold of 15% for at least 40% of the population. Caesarean rates were below 1% for the poorest 20% of the population in 20 countries, including Bangladesh, Pakistan, Nigeria and Ethiopia. However, in six countries – Chad, Madagascar, Niger, Ethiopia, Burkina Faso, and Mali - caesarean rates were below 1% for 80% of the population.

Estimates suggest that in any population, at least 1% of all pregnant women need surgical delivery to save their lives. The researchers increased the caesarean rate to 1% in every country that currently shows less than 1% and found that 80 000 births had an unmet need for surgical delivery. This represents 15% of the global estimate of maternal deaths in 2000.

Dr Ronsmans concludes: "There are many reasons for the huge shortfall in life-saving surgery among the very poor. In many poor countries functioning hospital services might simply not exist or cannot be reached…These data deserve the immediate attention of policymakers at national and international levels."

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See also accompanying Comment.

Contact: Carine Ronsmans, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. T) 0207 299 2190 carine.ronsmans@lshtm.ac.uk


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