`There is no clar­ity on how to op­ti­mise C-sec­tion rates'

Down to Earth - - HEALTH -

Alex B Haynes, pro­fes­sor of surgery at the Har­vard Med­i­cal School, speaks on the study on the re­la­tion­ship be­tween C-sec­tion rates and ma­ter­nal and neona­tal mor­tal­ity in 194 coun­tries. Ex­cerpts How can C-sec­tion rates be brought down? We are fac­ing sim­i­lar ques­tions in the US and other parts of the world. There is no clear an­swer as to how to op­ti­mise C-sec­tion rates. Our pop­u­la­tion data sug­gests the ben­e­fits to neona­tal and ma­ter­nal mor­tal­ity are not likely to ex­ist above 19 per cent. Our study looked only at mor­tal­ity, but there may be other rea­sons—re­duc­ing birth as­phyxia, de­creas­ing ob­stet­ri­cal fis­tula rates or avoid­ing ab­dom­i­nal wall her­nia, pla­centa ac­reta and other com­pli­ca­tions of sub­se­quent preg­nan­cies. Ad­di­tion­ally, we do not know what hap­pens when a coun­try raises or de­creases its C-sec­tion rates. What are the rea­sons for the dif­fer­ence be­tween your fig­ures (19 per cent) and those pro­posed by WHO (10-15 per cent) for op­ti­mal C-sec­tion rates in a pop­u­la­tion? Our study was in­tended not to make a firm rec­om­men­da­tion, but rather to pro­vide a sci­en­tif­i­cally rig­or­ous anal­y­sis of the cur­rent state of the re­la­tion­ship be­tween C-sec­tion and mor­tal­ity. WHO's rec­om­men­da­tions are not based on re­search alone, and the pre­vi­ous 10 per cent rec­om­men­da­tion was based largely on ex­pert con­sen­sus. Our study can help pol­i­cy­mak­ers de­vise in­formed pol­icy to op­ti­mise health out­comes.

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