Cesarean Delivery in the Developing World
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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Cited by (32)
Obstetrics in the Tropics
2023, Manson's Tropical Diseases, Fourth EditionEvaluation of a ketamine-based anesthesia package for use in emergency cesarean delivery or emergency laparotomy when no anesthetist is available
2016, International Journal of Gynecology and ObstetricsCitation Excerpt :These procedures represent two of the three consensus operations that predict surgical capability at a healthcare facility [1]. Cesarean delivery is the most frequently performed major surgery worldwide [3,6]. Immediate access to this procedure is necessary to reduce annual rates of maternal and newborn mortality.
Quality of caesarean delivery: A cross-sectional study in 12 hospitals in Benin
2016, Revue d'Epidemiologie et de Sante PubliqueChallenges affecting access to cesarean delivery and strategies to overcome them in low-income countries
2015, International Journal of Gynecology and ObstetricsCitation Excerpt :Ensuring access to a safe cesarean delivery when indicated is an important part of the path to a reduction in maternal mortality in these countries. Although the optimum rate of cesarean delivery remains controversial, estimating the appropriate rate is an important aspect of reducing neonatal and maternal mortality [6]. In 1985, WHO suggested that the rates of cesarean delivery should not be higher than 15% [7].
Defining the anesthesia gap for reproductive health procedures in resource-limited settings
2014, International Journal of Gynecology and ObstetricsCitation Excerpt :Additionally, the frequencies of some procedures are reduced, probably partly because of poor availability of anesthesia services. For example, the frequency of cesarean delivery in Sub-Saharan Africa is often between 1% and 5% of births, and sometimes lower, whereas WHO maintains that the optimum frequency should be 5%–15% [8,9]. The lack of anesthesia services in obstetrics is fully recognized [10].
Obstetrics in the Tropics
2013, Manson's Tropical Diseases: Twenty-Third Edition