Caesarean section rates in South Africa: A case study of the health systems challenges for the proposed National Health Insurance

Solanki, Geetesh; Cornell, Jennifer; Daviaud, Emmanuelle; Fawcus, Susan

doi:10.7196/samj.2020.v110i8.14699

Cited by 24 publications

(40 citation statements)

References 13 publications

(21 reference statements)

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“…Not specific to the Covid-19 lockdown, but a noteworthy finding is the high caesarean section rate in our study cohort (63%), a finding similar to other studies of private healthcare users in South Africa (60% [ 20 ]; 73% [ 21 ], 77% [ 22 ]). The WHO states that caesarean sections are medically necessary for 10–15% of all births [ 23 ].…”

Section: Discussionsupporting

confidence: 89%

Lockdown babies: Birth and new parenting experiences during the 2020 Covid-19 lockdown in South Africa, a cross-sectional study

Farley¹,

Edwards²,

Numanoglu³

et al. 2022

Women and Birth

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Section: Discussionsupporting

confidence: 89%

Lockdown babies: Birth and new parenting experiences during the 2020 Covid-19 lockdown in South Africa, a cross-sectional study

Farley¹,

Edwards²,

Numanoglu³

et al. 2022

Women and Birth

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“…Not specific to the Covid-19 lockdown, but a noteworthy finding is the caesarean section rate in our study cohort (63%), a finding similar to other studies of private healthcare users in South Africa (60% [19]; 73% [20], 77% [21]). The WHO states that caesarean section are medically necessary for 10 - 15% of all births [22].…”

Section: Discussionsupporting

confidence: 89%

Lockdown babies- Birth and new parenting experiences during the 2020 Covid-19 lockdown in South Africa

Farley¹,

Edwards²,

Numanoglu³

et al. 2021

Preprint

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Background Perceived birth experiences of parents can have a lasting impact on children. We explored the birth and new parenting experiences of South African parents during the Covid-19 lockdown. Methods We conducted an online cross-sectional survey with consenting parents of babies born in South Africa during 2020. Factors associated with negative birth emotions and probable depression were estimated using logistic regression. Results Most of the 520 respondents were females (n= 496, 95%) who gave birth at private hospitals (n=426, 86%). Mothers reported having overall positive birth emotions (n= 399, 80%). Multivariable analysis showed that having the baby during lockdown (adjusted odds ratio (aOR) 5.02; CI 1.28-19.66); being diagnosed with Covid-19 (aOR 3.17; CI 1.07-9.42); having negative new parenting emotions (aOR 6.07; CI 3.27-11.29); a preterm baby (aOR 3.02; CI 1.36-6.70) and lockdown related barring of preferred in hospital support (aOR 2.45; CI 1.35-4.43) were associated with mothers reporting predominately negative emotions about the birth. Having their chosen delivery method reduced the odds of negative birth emotions (aOR 0.4; CI 0.22-0.72). Multivariable analysis showed that having predominantly negative new parenting emotions (aOR 10.75; CI 5.41-21.37), breastfeeding struggles (aOR 2.16; CI 1.36-3.46); lockdown preventing health care access (aOR 2.06; CI 1.20-3.54) and creating financial strain (aOR 2.58; CI 1.08-6.18) were associated with probable minor depression Conclusions Lockdown exacerbated many birth and parenting challenges including mental health and health care access. However, overall experiences were positive and there was a strong sense of resilience amongst parents.

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“…We drew on a framework previously developed by members of our research team which outlines drivers, challenges and required action for obstetric care in preparing for NHI. 15 The interviews were read and reread by members of the team to familiarise ourselves with the content. Emerging categories and major themes were identified and mapped against the framework and quantitative findings.…”

Section: Methodsmentioning

confidence: 99%

“…A framework analysis14 approach was applied, which is well suited to implementation research designs. We drew on a framework previously developed by members of our research team which outlines drivers, challenges and required action for obstetric care in preparing for NHI 15. The interviews were read and reread by members of the team to familiarise ourselves with the content.…”

Section: Methodsmentioning

confidence: 99%

Utilisation of private general practitioners to provide caesarean deliveries in five rural district public hospitals in South Africa: a mixed-methods study

et al. 2023

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ObjectiveResearching how public–private engagements may promote universal access to safe obstetric care including caesarean delivery is essential. The aim of this research was to document the utilisation of private general practitioners (GPs) contracted to provide caesarean delivery services in five rural district hospitals in the Western Cape, the profile and outcomes of caesarean deliveries. We also describe stakeholder experiences of these arrangements in order to inform potential models of public–private contracting for obstetric services.DesignWe used a mixed-methods study design to describe rural district hospitals’ utilisation of private GP contracting for caesarean deliveries. Between April 2021 and March 2022, we collated routine data from delivery and theatre registers to capture the profile of deliveries and maternal outcomes. We conducted 23 semistructured qualitative interviews with district managers, hospital-employed doctors and private GPs to explore their experiences of the contracting arrangements.SettingThe study was conducted in five rural district hospitals in the Western Cape province, South Africa.ResultsThe use of private GPs as surgeon or anaesthetist for caesarean deliveries differed widely across the hospitals. Overall, the utilisation of private GPs for anaesthetics was similar (29% of all caesarean deliveries) to the utilisation of private GPs as surgeons (33% of all caesarean deliveries). The proportion of caesarean deliveries undertaken by private GPs as the primary surgeon was inversely related to size of hospital and mean monthly deliveries. Adverse outcomes following a caesarean delivery were rare. Qualitative data provided insights into contributions made by private GPs and the contracting models, which did not incentivise overservicing.ConclusionThe findings of this study suggest that private GPs can play an important role in filling gaps and expanding quality care in rural public facilities that have insufficient obstetric skills and expertise. Different approaches to enable access to safe caesarean delivery are needed for different contexts, and contracting with experienced private GP’s is one resource for rural district hospitals to consider.

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Caesarean section rates in South Africa: A case study of the health systems challenges for the proposed National Health Insurance

Cited by 24 publications

References 13 publications

Lockdown babies: Birth and new parenting experiences during the 2020 Covid-19 lockdown in South Africa, a cross-sectional study

Lockdown babies: Birth and new parenting experiences during the 2020 Covid-19 lockdown in South Africa, a cross-sectional study

Lockdown babies- Birth and new parenting experiences during the 2020 Covid-19 lockdown in South Africa

Utilisation of private general practitioners to provide caesarean deliveries in five rural district public hospitals in South Africa: a mixed-methods study

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