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

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.