The rate of caesarean sections is rising to levels that are medically unnecessary and potentially harmful, experts say.
In Kenya, C-sections constitute about 8.9 per cent of all births, the World Health Organization says in a new study.
The rate is higher in urban areas at about 16 per cent.
Globally, C-sections now account for more than one in five (21 per cent) of all childbirths and are expected to rise to 29 per cent by 2030.
The study notes while a C-section can be essential and lifesaving, it can put women and babies at unnecessary risk of short- and long-term health problems if performed when there is no medical need.
“Not all the caesarean sections carried out at the moment are needed for medical reasons. Unnecessary surgical procedures can be harmful, both for a woman and her baby,” said Dr Ian Askew, director of WHO’s department of sexual and reproductive health and research.
The study, ‘Trends and Projections of Caesarean Section Rates: Global and Regional Estimates’, is published in the BMJ Global Health Journal.
Researchers analysed nationally representative data on the CS rate from countries worldwide from 1990 to 2018.
In sub-Saharan Africa, CS levels are generally low at five per cent, but highest in Kenya.
In a 2015 study, Dr Joseph Oguta and obstetrician Dr Koigi Kamau placed the levels in Nairobi at 16 per cent. “Proactive measures are essential to maintain healthy levels and prevent unnecessary CS incidences,” they said.
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.
In 2018, the National Hospital Insurance Fund paid hospitals Sh1.2 billion for caesarean births.
"C-sections carry risks such as the potential for heavy bleeding or infection, slower recovery times after childbirth, delays in establishing breastfeeding and skin-to-skin contact, and increased likelihood of complications in future pregnancies," WHO study says.
In 1995, the world health body asserted that a CS rate above 10 - 15 per cent confers no additional health benefits.
However, the agency now says it will not recommend a specific target rate.
“It’s important for all women to be able to talk to healthcare providers and be part of the decision-making on their birth, receiving adequate information including the risks and benefits,” Dr Ana Pilar Betran, a medical officer at WHO, said in a statement.
WHO recommended some non-clinical actions that can reduce medically unnecessary use of caesarean sections, within the overall context of high quality and respectful care.
They include educational interventions that engage women actively in planning for their birth such as childbirth preparation workshops, relaxation programmes and psychosocial support where desired, for those with fear of pain or anxiety.
It called for financial strategies that equalise the fees charged for vaginal births and caesarean sections.
Edited by Henry Makori
