•Although it's impossible to know the “necessary” rate of caesarian with real precision, WHO says it is closer to 10 or 15 per cent.
•The Ministry of Health notes the Kenyan government’s campaign encouraging women to give birth in health facilities has contributed to the high C-sections.
The share of Kenyans delivering babies via caesarian section has crossed the recommended limit and is almost twice the average for Africa, a Ministry of Health report shows.
The ministry said the rate of C-sections rose from 14.5 per cent in 2017 to 16.4 per cent in 2021.
The average C-section rate for Africa is about 9.2 per cent, according to the World Health Organisation.
Although it is impossible to know the necessary rate of caesarian with real precision, the WHO says it is between 10 to 15 per cent.
There is no evidence that maternal and child mortality rates improve when the rate goes above 10 per cent. Anything above 15 per cent implies that the procedure is probably being abused, the organisation says.
The Ministry of Health report notes the Kenyan government’s campaign encouraging women to give birth in health facilities has contributed to the high amount of C-sections.
“However, the changing trend is not homogeneous across the country when compared across the 47 counties,” the National Reproductive Health Policy 2022-2032 says.
In some counties, such as Kiambu and Nairobi, C-sections are as high as 25 per cent and as low as two per cent in Mandera, Wajir, and Tana River.
Deliveries in health facilities rose from 53 per cent in 2017 to 79.3 per cent in 2021.
“This increase resulted in an attendant rise in Caesarean section rates,” the report suggests.
However, in 2020, Moi University School of Medicine dons published results of a study suggesting C-sections were driven mainly by working women.
Gynaecologist Dr Hillary Mabeya and his colleagues analysed records of 12,209 women who gave birth at the Moi Teaching and Referral Hospital in 2014.
Most women (58 per cent) were housewives while a minority (11 per cent) had a professional occupation.
However, professional women contributed a total of 21 per cent of all c-sections.
Housewives contributed 15.8 per cent.
The researchers also noted that all women who had an unnecessary C-section for their first child were given c-sections in their subsequent pregnancies.
“Nearly all women with a previous C-section had a repeat C-section for their subsequent pregnancy,” they said.
Their study – Socioeconomic differences in caesarean section: are they explained by medical need? An analysis of patient record data of a large Kenyan hospital – was published in the International Journal for Equity in Health.
One of the reasons medics recommends caesarean sections is probably because they earn more money from them.
In 2017 the National Hospital Insurance Fund paid Sh1 billion for c-sections, accounting for 61 per cent of the fund’s maternity costs.
The 15 per cent upper limit is based on the following statement by a panel of reproductive health experts at a meeting organized by the WHO in 1985 in Brazil: “There is no justification for any region to have a rate higher than 10-15 per cent.”
The WHO says a caesarean section can put women and babies at unnecessary risk of short- and long-term health problems if performed when there is no medical need.
Caesarean sections can be essential in situations such as prolonged or obstructed labour, fetal distress, or because the baby is presenting in an abnormal position.
However, as with all surgeries, they can have risks.
These include 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.