In Kirinyaga and Kiambu, nearly half of all women are going for c-sections as opposed to vaginal birth, making this one of the highest rates in Africa.
The rate of C-section in Kirinyaga is 40 per cent, Kiambu 33 per cent and Tharaka Nithi 30 per cent.
In total, 19 counties have already breached the World Health Organization's recommended upper limit of 15 per cent, the Kenya Demographic and Health Survey 2022 shows.
This raises prospects of overuse of the procedure, which carries risks for both babies and mothers.
The National Health Insurance Fund also complains hospitals may be pushing some women into CS births because the surgery generates more money.
The insurer paid Sh621 million for C-sections in 2016-17, jumping to Sh1.5 billion in 2018-2019.
In 2019-2021 NHIF paid hospitals Sh2.5 billion for caesarean section births, accounting for 44 per cent of NHIF’s maternity costs of Sh5.67 billion that financial year.
The KDHS 2022 survey suggested these procedures are probably being abused, despite the risks.
Past studies have indicated the death rate among women undergoing a C-section to deliver a baby is about 50 times higher in Africa than in most wealthy nations.
“Unnecessary caesarean sections can be harmful to both the mother and the baby, leading to heavy bleeding, infection, slower recovery times, delays in breastfeeding, and future complications in pregnancies,” the KDHS report said.
However, the Kenya Medical Association said rather than striving to achieve a specific rate, medics should ensure all women who need CS can access the service.
"CS rate thus is not to be regulated. Antenatal care and monitoring of labour and delivery is important to ensure safe delivery of women, avoiding maternal morbidity and mortality and ensuring that a healthy baby is born and that no mother who requires a cesarean section is denied one," KMA president and gynaecologist Dr Simon Kigondu told the Star.
The Kenya National Bureau of Statistics, which produced the survey, said C-sections have doubled in Kenya since the last survey in 2014.
“According to the WHO, the optimal population-level caesarean section rate should be within the range 10–15 per cent based on medical indications,” said Macdonald Obudho, the KNBS director general.
There is no evidence that maternal and child mortality rates improve when the rate goes above 10 per cent, at the population level. Anything above 15 per cent implies that the procedure is probably being abused, the WHO suggests.
KNBS listed the 19 counties that have already crossed the WHO upper limit.
These are Kirinyaga, Kiambu, Tharaka Nithi, Nairobi City (28 per cent), Taita/Taveta (27 per cent), Kajiado (23.3 per cent), Makueni (22.5 per cent), Meru (22 per cent), Embu (22 per cent), Kisii (21.7 per cent), Kericho (21.3 per cent), Murang’a (19.7 per cent), Lamu (19.4 per cent), Mombasa (18.8 per cent), Nyeri (18.1 per cent), Machakos (17 per cent), Vihiga (16.5 per cent), Bomet (15.9 per cent), Siaya (15.7 per cent).
The counties with the lowest caesarean section delivery rates are Wajir (2 per cent), Mandera (4 per cent), Turkana (4 per cent), and Samburu (5 per cent).
Dr Kigondu said a low C-section rate is not necessary a good thing because it may mean women who need the service cannot access it, and therefore have worse outcomes.
"For instance if an area has a low CS rate but at the same time the rate of obstetric fistula is high then a low CS rate is not necessarily a positive thing," he said.
The KDHS report also shows a third (33 per cent) of all rich women in the highest wealth bracket opt for C-section.
Educated women are also more likely to get C-sections. “The percentage of live births delivered by caesarean section increases with mother’s level of education; from 3 per cent for mothers with no education to 34 per cent for those with more than secondary education,” KNBS data showed.
Nationally, 17 per cent of all live births and stillbirths in the two years before the survey were delivered by caesarean section.
The average C-section rate in Africa is about 9.2 per cent, according to the WHO.
Globally the average is 21 per cent and up to 40 per cent in Latin America, and the Caribbean. In Egypt and Turkey, most births are via CS, WHO says.
In 2019, the Lancet Global Health reported that the unsafest place to have a C-section is Africa because the death rate of women undergoing a C-section to deliver a baby is about 50 times higher than in most wealthy nations.
Preventable C-section deaths in Africa mostly stem from a ruptured uterus, in mothers who had pre-existing placental complications, bleeding before birth or during surgery, and problems related to anaesthesia.
The findings were part of the Africa Surgical Outcomes Study, which tracks all patients who received surgery at 183 hospitals across 22 countries for seven days.
However, a widely circulated 2016 WHO Statement on Caesarian Births said these risks are only higher in women with limited access to comprehensive obstetric care.
"When medically justified, a caesarean section can effectively prevent maternal and perinatal mortality and morbidity."
The WHO advises health facilities to use the Robson classification system to assess and monitor CSs.
Dr Marleen Temmerman, a gynaecologist at the Aga Khan University Hospital in Nairobi, co-authored a response to WHO statement, calling for an end to debate about the right C-section rate.
"CS should be undertaken when medically necessary, and rather than striving to achieve a specific rate, efforts should focus on providing caesarean section to all women in need," she wrote in the British Journal of Obstetrics and Gynaecology.
WHO says C-sections can be essential in situations such as prolonged or obstructed labour, fetal distress, or because the baby is presenting in an abnormal position.
Guidelines from the Kenya Medical Practitioners and Dentists Council state that C-sections should be carried out when the life of the mother and baby are in danger.
The council partly attributes the rise in Kenya to greed because private hospitals earn more from C-sections compared to natural births.
THE RISE OF C-SECTIONS IN KENYA
2014: 9 per cet of all births
2022- 17 per cent of all births
NHIF payout for CS, 2016: Sh621 million
2022: Sh2.5 billion
Highest: Kirinyaga 40 per cent
Kiambu 33 per cent
Lowest: Wajir (2 per cent), Mandera (4 per cent), Turkana (4 per cent),
