C-section births rise rapidly to more than 20 percent worldwide

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"The large increases in C-section use - mostly in richer settings for non-medical purposes - are concerning because of the associated risks for women and children", said Marleen Temmerman, an expert from Aga Khan University in Kenya and Ghent University in Belgium who co-led the research.

Evidently, between the year 2000 and 2015, the rate of c-section births increased from 12 percent to 21 percent, with those in richer countries overusing it and those in poorer countries continue to have little access to a possibly life-saving procedure.

It says there is an over-reliance on Caesarean section procedures - when surgery is used to help with a hard birth - in more than half of the world's nations. The South Asia region has seen the most rapid increase in use (6.1 per cent per year), with C-section being underused in 2000 but overused by 2015 (increasing from 7.2 per cent of births to 18.1 per cent).

The procedure can save lives when complications occur, such as bleeding, fetal distress, hypertensive disease, and babies in abnormal position.

"C-section is a type of major surgery, which carries risks that require careful consideration".

Scientists have identified 15 countries where more than 40 percent of babies are born by caesarean section.

Jane Sandall, professor of social science and women's health at King's College London and a study author, said that there were a variety of reasons women were increasingly opting for surgery.

In total, 60 percent of the countries were found to overuse c-sections, while 25 percent under-use it.

Today, however, many countries are failing to meet this recommendation - which is not flawless but does provide guidance.

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The authors found that the global increases in C-section use are attributed both to more births taking place in health institutions (about two-thirds of the increase) and to greater frequency of intervention through C-section in health facilities (one-third of the increase). They also advocated for increasing midwifery care and ensuring doctors are making evidence-based decisions to use C-sections.

In North America (32% of Caesareans in 2015) and Western Europe (26.9%), the increase is approximately 2% per year. In some parts of the world, they actually outnumber natural births.

Looking at trends in Brazil and China where there is high use of C-section, the authors found that most C-sections were in low-risk pregnancies and in women who had previously had a C-section.

"In some cases the trend is system-driven".

Wealth provides a certain privilege, where women can choose to undergo c-sections for non-medical reasons, like fear of labor, pelvic floor damage, and reduced sexual function.

There were also significant disparities within low- and middle-income countries, where the wealthiest women were six times more likely to have a C-section compared with the poorest women, and where C-section was 1.6 times more common in private facilities than public facilities.

Some medical professionals also have strong financial incentives to push for surgery and are less likely to be sued after an elective c-section.

Nearly two-thirds of all countries overuse the procedure while a quarter underuse it, highlighting a sharp disparity in the extent to which medical facilities adhere to established recommendations for employing C-sections, as well as disparities in access to proper care. "Joint actions with governmental bodies, the health care insurance industry, and women's groups are urgently needed to stop unnecessary C-sections and enable women and families to be confident of receiving the most appropriate obstetric care for their individual circumstances".

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