Rising rates of c-sections globally
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Rising Rates of C-Sections Globally
Global Trends in Caesarean Section Rates
The global rate of caesarean sections (C-sections) has seen a significant increase over the past few decades. According to data from 150 countries, the global average C-section rate rose from 6.7% in 1990 to 19.1% in 2014, with an average annual rate of increase of 4.4%. By 2018, the global C-section rate had further increased to 21.1%. Projections indicate that by 2030, approximately 28.5% of women worldwide will give birth via C-section.
Regional Variations in C-Section Rates
There are notable regional differences in C-section rates. Latin America and the Caribbean have the highest rates, with 42.8% of births delivered by C-section. In contrast, sub-Saharan Africa has the lowest rates, at around 5%. Other regions such as Northern America, Oceania, and Europe also show high C-section rates, ranging from 25% to 32.3%. The disparity between high-income and low-income regions is stark, with the former often having much higher rates of C-sections .
Socioeconomic and Health System Factors
Several factors contribute to the rising rates of C-sections globally. In Indonesia, for example, the C-section rate increased from 4.0% in 1998 to 18.5% in 2017, with higher rates observed in urban areas and among wealthier populations. Higher maternal education, primiparity, and the use of public childbirth services were also associated with increased C-section rates. Similarly, in South Asia, factors such as higher maternal age, higher economic status, and urban residency were significant contributors to the rising C-section rates.
Maternal Request and Autonomy
One of the key drivers of the increase in C-sections is maternal request. In some regions, such as the Middle East and East Asia, maternal request accounts for a significant proportion of C-sections, with rates ranging from 0.2% to 42% of all deliveries. In Brazil, a law that increased women's autonomy to choose C-sections even when not medically necessary led to a 3% increase in overall C-section rates .
Medical Indications and Obstetric Practices
Medical indications for C-sections, such as fetal distress, previous C-sections, and complications like placenta previa, also play a crucial role in the rising rates. The use of the Robson classification system has helped identify specific obstetric populations contributing to the increase, such as women with previous C-sections and those undergoing induction or prelabour C-sections.
Implications for Maternal and Neonatal Health
The rising rates of C-sections have significant implications for maternal and neonatal health. While C-sections can be life-saving when medically necessary, unnecessary procedures can lead to increased risks of complications such as placenta accreta, stillbirth, and ectopic pregnancy in subsequent pregnancies. Additionally, children born via C-section have a higher incidence of asthma and obesity.
Conclusion
The global increase in C-section rates is a complex issue influenced by socioeconomic factors, maternal request, medical indications, and obstetric practices. Addressing this trend requires a multifaceted approach, including better education for expectant mothers, improved obstetric care, and policies aimed at reducing unnecessary C-sections. As the world moves towards achieving the Sustainable Development Goals, optimizing the use of C-sections remains a global priority.
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