Deaths from caesarean sections are higher in low and middle-income countries, suggesting a threat to the lives of women and babies there, as per a study in the recent issue of The Lancet journal.
All the deaths following caesarean section could be attributed to postpartum haemorrhage (32 per cent), pre-eclampsia (19 per cent) and sepsis (22 per cent), and 14 per cent to anaesthesia related causes.
This observation rings alarm bell for India where number of babies born through caesarean section increased from nine per cent in 2005-6 to 18.5 per cent in 2015-16.
This was highlighted in a series of three papers published in the same journal last year, which also found that C-section use almost doubled worldwide between 2000 and 2015.
The study found that maternal deaths in low and middle-income countries are 100 times higher, particularly in sub-Saharan Africa and the Middle East, than in some high-income countries, and that a third of all babies in some regions do not survive caesarean section.
Yet another study by Indian Institute of Management-Ahmedabad points out that there were as many as nine lakh “preventable” unplanned Caesarean section (C-section) deliveries out of 70 lakh in private hospitals in India in one year, driven mainly by “financial incentives.”
Such “medically unjustified” births not just cause “large out-of-pocket expenses” but also “delayed breastfeeding, lower birth-weight, respiratory morbidities” among other troubles for the newborn, it says.
The study titled “Too much care? Private health care sector and surgical interventions during childbirth in India,” was carried out by IIM-A faculty member Ambrish Dongre and doctoral student Mitul Surana.
The study found “a woman opting for private facility is 13.5-14 percentage points more likely to undergo an unplanned C-section (compared to public facilities)”.
The figure is based on the fourth round of the National Family Health Survey (NFHS), carried out in 2015-16, which found that 40.9 per cent births in private facilities in India were through C-section as against 11.9 per cent in public facilities.
Quoting NFHS, the IIMA study says that a natural birth in private facility costs, on an average, Rs 10,814, while a C-section costs Rs 23,978.
“The supplier-induced demand driven by financial incentives especially when patient has limited information is probably an important explanation” for higher rate of C- section birth in private facilities, it further says.
“When medically justified, C-sections prevent maternal and perinatal mortality and morbidity. But if performed when not needed, they impose huge burden on the mother and the child that go beyond large out-of-pocket expenses,” the study states.
“For the newborn, it means delayed breastfeeding, lower birth weight, respiratory morbidities, increased rate of hospitalisation, lower Apgar scores and its implication in the long run,” it says.