Elsevier

Clinics in Perinatology

Volume 35, Issue 3, September 2008, Pages 571-582
Clinics in Perinatology

Cesarean Delivery in the Developing World

https://doi.org/10.1016/j.clp.2008.06.002Get rights and content

Two trends are apparent regarding cesarean delivery in the developing world. In the least developed countries, access to the procedure remains limited at levels much less than 5% of all births. This limited access is linked with increases in maternal and neonatal mortality. Safety concerns are equally valid when more than half of women in certain socioeconomic strata are having surgical delivery, as is evident in the more advanced developing economies of Latin America and China. The optimal minimum and maximum cesarean delivery rates continue to be a matter of debate and may never be resolved; however, these two extremes of cesarean delivery use evident in the developing world deserve critical examination.

Section snippets

Background

The label “developing country” is often inappropriately attached to any country that is not fully developed. The term implies that economic development and progress are occurring, yet many poor countries have experienced ongoing economic decline. On the other hand, some developing countries have demonstrated impressive economic growth and increasing industrialization (eg, Brazil, China, Egypt, India, Mexico, Poland, Russia, South Africa, South Korea, and Turkey).5 Lumping these types of

Prevalence

A major obstacle to determining accurate estimates of CD rates in developing countries is the lack of reliable data at the national level.8 Vital statistics registries, when they do exist, may not capture the mode of delivery. Population-based CD rates are primarily derived from demographic and health surveys, which are highly standardized surveys of nationally representative samples of women of reproductive age. Questions regarding obstetric care, including method of delivery, are asked of any

Limited access in least developed countries

Obstetric practice in least developed countries is plagued by challenges that seem implausible in the developed world. For many women, there simply is no nearby facility at which CD is an option. The capability of a facility to perform CD is considered by the UN and WHO as one of the key indicators of comprehensive emergency obstetric care.4 Over the past decade, increasing attention has been paid to the availability and distribution of comprehensive emergency obstetric care facilities in the

Cesarean delivery as an emerging cultural norm in more advanced developing nations

In contrast to the least developed nations, where rates have remained alarmingly low and unchanged, the more advanced regions of the developing world have experienced an overall increase in the proportion of CDs over the past decade, presumably reflecting an improvement in health care access.3 The UN notes that the number of deliveries performed by a skilled attendant increased globally from 41% to 57% during the 1990s, with an increasingly higher proportion performed by physicians.24

Although

Summary

CD is inextricably linked with wealth at national and individual levels. The alarmingly low rates of CD in least developed nations represent a failure on the part of the global society to care for the most vulnerable populations. Increasing access to CD for women who live in these countries will increase maternal survival, decrease maternal morbidities, and likely improve neonatal survival. Increasing access to safe CD requires more than simply building operating rooms. Significant commitments

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