Rising use of caesarean delivery in developing countries is linked to a greater risk of death and sickness for mother and baby alike, according to a study by UN experts.
Caesarean rates have risen from about five percent in developed countries in the early 1970s to more than 50 percent in some nations today.
In poorer countries, there has also been a big rise, although the picture is sketchy, particularly on the key question as to whether caesareans are beneficial.
Exploring this, a team led by Jose Villar of a UN- and World Bank-backed programme assessed the outcome of caesarean delivery in eight Latin American countries — Argentina, Brazil, Cuba, Ecuador, Mexico, Nicaragua, Paraguay and Peru.
They randomly selected 120 public, private and social-security hospitals from 24 geographic regions where 97 000 babies were born, about a third of whom were delivered by caesarean.
The researchers found that in hospitals where there were higher rates of caesareans, there were correspondingly higher rates of pre-term babies, babies who died after birth, maternal death and use of antibiotics.
"High rates of caesarean delivery do not necessarily indicate good quality care or services," the paper, published online by the British journal The Lancet, says.
Caesarean delivery entails making an incision in the uterus to remove the baby, rather than delivering it through the vagina.
The operation is often recommended in cases when the shape and size of the pelvis makes a vaginal birth difficult; when there are multiple births; in cases of foetal distress; or if the mother is ill or has dangerously high blood pressure.
The study says the surge in the number of caesareans in Latin America has complex reasons, ranging from a country’s legal system to family and social pressures and endorsement of caesareans by celebrity role models.
In addition to the heightened risk, lots of money is being wasted on unnecessary caesareans, the study suggests.
A rough estimate is that two million more children are being born in Latin America by caesarean these days, at an extra cost of around 350 dollars each when compared with vaginal delivery.
"These large sums of money (spent on unneeded caesareans) could be used to improve other areas of maternal and newborn care to pay for needed research," it says.
