Caesarean section and subsequent fertility in sub‐Saharan Africa

Abstract

Objective To determine the impact of caesarean section on fertility among women in sub-Saharan Africa.Design Analysis of standardised cross-sectional surveys (Demographic and Health Surveys).Setting Twenty-two countries in sub-Saharan Africa, 1993Africa, -2003 Sample A total of 35 398 women of childbearing age (15-49 years).Methods Time to subsequent pregnancy was compared by mode of delivery using Cox proportional hazards regression models.Main outcome measures Natural fertility rates subsequent to delivery by caesarean section compared with natural fertility rates subsequent to vaginal delivery.Results The natural fertility rate subsequent to delivery by caesarean section was 17% lower than the natural fertility rate subsequent to vaginal delivery (hazard ratio = 0.83, 95% CI 0.73-0.96, P < 0.01; controlling for age, parity, level of education, urban/rural residence and young age at first intercourse).Caesarean section was also associated with prior fertility and desire for further children: among multiparous women, an interval ‡3 versus <3 years between the index birth and the previous birth was associated with higher odds of caesarean section at the index birth (OR = 1.4, 95% CI 1.1-1.7, P = 0.005); among all women, the odds of desiring further children were lower among women who had previously delivered by caesarean section (OR = 0.67, 95% CI 0.54-0.84, P < 0.001). Caesarean section did not appear to increase the risk of a subsequent pregnancy ending in miscarriage, abortion or stillbirth.Conclusions Among women in sub-Saharan Africa, caesarean section is associated with lower subsequent natural fertility. Although this reflects findings from developed countries, the roles of pathological and psychological factors may be quite different because a much higher proportion of caesarean sections in subSaharan Africa are emergency procedures for maternal indication.

The risk factor profile of women with secondary infertility: an unmatched case-control study in Kigali, Rwanda

“…A history of dilatation and curettage, which was weakly associated with secondary infertility in our population, has been associated with pelvic inflammatory disease (PID) but not with infertility in other studies [16]. In our study, we did not find an association between caesarean section and secondary infertility, but this could be due to insufficient statistical power [6,17,18]. …”

Fertility desires and the feasibility of contraception counseling among genital fistula patients in eastern Democratic Republic of the Congo

“…Studies of traumatic birth experience have demonstrated decreased subsequent fertility [14]. An analysis of Demographic and Health Surveys data from 22 countries in Sub-Saharan Africa, using cesarean delivery as a proxy measure for a complicated obstetric experience, found decreased subsequent fertility and desire for children, and increased contraceptive use in the population with previous cesarean [15]. A small study in Eritrea assessing 1-on-1 comprehensive fistula counseling, which included mention of family planning, found that women with fistula were more interested in family planning when presented with information about contraception, although no access to contraception was offered and contraceptive knowledge and use were not assessed [16].…”

First Caesarean Section and Subsequent Infertility

“…This suggests that the increasing infertility was not related to the indication of CS; therefore, reduced fertility in the second birth was due to the CS complications (12 On the other hand, infertility after CS was reported in developed countries, which reflects the differences in pathological and psychological factors, because most of CS indications in sub-Saharan Africa are emergency procedures for maternal indication, while in developed countries the desire of women for CS is the most indication for CS (13). Furthermore, Tanimura S et al assessing 22 women with secondary infertility showed that infertility was associated with post-cesarean scar defect (14).…”