Increases in Caesarean Delivery Rates and Change of Perinatal Outcomes in Low‐ and Middle‐Income Countries: A Hospital‐Level Analysis of Two WHO Surveys

Zhao, Yongjie; Zhang, Jun; Zamora, Javier; Vogel, Joshua P.; Souza, João Paulo; Jayaratne, Kapila; Ganchimeg, Togoobaatar; Ortíz-Panozo, Eduardo; Hernández, Bernardo; Oladapo, Olufemi T.; Torloni, Maria Regina; Morisaki, Naho; Mori, Rintaro; Pileggi-Castro, Cynthia; Tuncalp, Oezge; Shen, Xiaoming; Betrán, Ana Pilar

doi:10.1111/ppe.12363

Cited by 21 publications

(18 citation statements)

References 30 publications

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“…These problems range from a lack of consistent supplies and equipment at health facilities, insufficient referral systems, inadequate training and supervision of health workers, to lack of respectful maternity care. Harmful practices are another reflection of poor quality of care and can be inadvertently incentivized by UHC financing strategies, such as the inappropriate use of antibiotics, 54 caesarean sections 55 or hysterectomies. 56…”

Section: Driversmentioning

confidence: 99%

Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Boerma¹,

Requejo²,

Victora³

et al. 2018

The Lancet

325

295

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Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH.

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Section: Driversmentioning

confidence: 99%

Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Boerma¹,

Requejo²,

Victora³

et al. 2018

The Lancet

325

295

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“…current levels is not associated with improvements in maternal or neonatal outcomes. [8][9][10][11] Given that around a third of women in many high-income countries have a cesarean birth, 3,12 understanding women's experiences of having a cesarean is important. A better understanding of women's experiences of a cesarean will help identify opportunities to improve women's experience of care and to provide clinicians with the information required to better prepare women for the reality of having a cesarean birth.…”

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confidence: 99%

Women’s experiences and satisfaction with having a cesarean birth: An integrative review

Coates

Thirukumar

Henry

2019

Birth

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Background With around one third of woman having a cesarean birth, better understanding of women's experiences of having a cesarean is vital to improve women's experiences of care. The aim of this review was to gain insight into women's experiences of and satisfaction with cesarean and to identify factors that contribute to women's poor experiences of care. Methods Using an integrative methodology, evidence was systematically considered in relation to women's experiences of cesarean birth and whether they were satisfied with their experience of care. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018, and reference lists of included studies were examined. Results Twenty‐six studies were included. Although the majority of women were satisfied with their cesarean, a large minority of women were dissatisfied and reported a negative experience. In particular, women who had an emergency cesarean were less satisfied than women who had a vaginal birth. Nonmedical factors or experiences that appear associated with dissatisfaction include (a) feeling ignored and disempowered; (b) experiencing a loss of control; (c) not being informed; and (d) birth values that favor vaginal birth. Conclusions Women's experiences of cesarean birth appear influenced by the circumstances (emergency vs planned), the extent to which they felt involved in decision‐making and in control of their experience, and their birth values and beliefs. Increasing antenatal, intrapartum, and postpartum communication and shared decision‐making may help engage women as an active participant in their own birth.

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“…A report from the Millennium Development Goals (MDGs) shows that, between 1990 and 2015, the maternal mortality rate has declined by 45% worldwide, and 49% in sub-Saharan Africa. 1 Despite that, the sharp increase in caesarean rates in the last decades, especially in low and middle-income countries, 2,3 exceeding the upper limit proposed by the World Health Organization (WHO) (10% -15%) has become a public health problem worldwide. 4 Unnecessary caesarean sections result in avoidable suffering and wasted health care resources from unduly allocated staff, surgical procedures and longer hospital stays.…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic Determinants of Caesarean Delivery in the Largest Public Maternity Hospital in Angola

et al. 2019

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Introduction: This study aimed to describe demographic, socioeconomic and pregnancy-related characteristics associated with a caesarean delivery in Luanda.Material and Methods: We conducted a cross-sectional study which included 995 puerperal women and who were assessed between December 2012 and February 2013 at Lucrécia Paím maternity hospital in Luanda, Angola. Data was collected using a structured questionnaire administered by trained interviewers. Logistic regression models were fitted to estimate the magnitude of associations (odds ratios—95% confidence intervals) between the type of delivery and variables showing a significant association in the bivariate analysis.Results: The prevalence of caesarean section was 44%. Women with caesarean delivery were less educated, resided more often in a periurban area and were more likely to disclose lower family income when compared with women who had vaginal delivery. Living in a periurban area was significantly associated with a caesarean delivery regardless of all covariates considered, for primiparous women (adjusted odds ratios, 95% confidence intervals = 2.14, 1.27 – 3.62) and for multiparous women (1.78, 1.26 – 2.51). Among multiparous women, a lower family income was also significantly associated with caesarean delivery. Hypertensive disorders during the current pregnancy were associated with a caesarean delivery in the multivariate models fitted for primiparous (3.96, 1.57 – 9.98) and for multiparous women (1.68, 1.03 – 2.74).Discussion: The associations between low socioeconomic position and high risk of caesarean delivery demonstrated in this study are consistent results in previous researches curried out in African contexts. The poorer and less educated women, who live far from health facilities, have few antenatal care visits and often arrive with complicated conditions, justifying a caesarean delivery. Lack of qualified human and material resources to manage emergencies in peripheral health centers and delaying in the reference system also leads to an increase in the number of caesareans performed in this particular maternity hospital.Conclusion: Sociodemographic differences were observed according to the type of delivery. Cesarean section was more prevalent among women with lower income and residents in periurban areas.

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Increases in Caesarean Delivery Rates and Change of Perinatal Outcomes in Low‐ and Middle‐Income Countries: A Hospital‐Level Analysis of Two WHO Surveys

Abstract: In low- and middle-income countries, the increases in caesarean rates were not associated with improved perinatal outcomes regardless of whether the starting caesarean rate was already high or not.

Cited by 21 publications

References 30 publications

Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Women’s experiences and satisfaction with having a cesarean birth: An integrative review

Sociodemographic Determinants of Caesarean Delivery in the Largest Public Maternity Hospital in Angola

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