Why are C-section births increasing in Uganda?

Monday August 03 2020
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The number of births by cesarean section (C-section) is increasing rapidly all around the world.
Studies and evidence indicate that the Dominican Republic has the highest global rate (58 per cent) and is closely followed by Brazil and Egypt with each standing at 56 per cent.

At 29 per cent, the C-section rate is considerably lower in Uganda (perhaps due to our under-developed healthcare system) but the pace at which it is growing is alarming.

For instance, in the 2018/19 Health Sector Review Report, it was reported that Nakasero Hospital in Kampala had the highest C-section rate at 72 per cent in the country.

In simple terms, this means that 7 in 10 deliveries conducted at Nakasero Hospital during that period were via C-section.

So, what has caused the shift away from natural childbirths? This is a question both patients and doctors worry over, with an answer that is by no means straightforward.

Without a doubt, a C-section may not only be preferable but mandatory in some situations and could be a life-saver for both mother and child.

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However, if conducted for non-medical emergencies, the procedure can pose severe risks in form of infections, blood loss, complications in future pregnancies or death. Even if serious complications do not occur, C-section births seem to increase the burden of cost on the health system.

Studies and expert consensus are quite consistent on the message that the rising C-section rates are attributable to doctors and hospitals. It has been frequently reported that doctors prefer C-section births mainly because of the related financial incentives.

In addition to being paid more money for a C-section birth, obstetricians generally require a shorter time period to perform it as compared to a normal delivery.

Performing a C-section could require may-be an hour or two of work while delivering babies naturally might involve intermittent work spanning over a 24-hour period.

It has also been reported that some women in labour opt for C-sections because they feel humiliated by the doctors.

In a survey conducted in Brazil, of the 1,626 women who had given birth, about a quarter of them said the doctor made fun of their behaviour or criticised them for their cries of pain. Over half of them said during the childbirth, they felt, “inferior, vulnerable, or insecure”.

Along with these structural explanations are cultural ones as well. You will appreciate that C-section rates are much lower among rural-based women if compared to their counterparts in towns or urban areas.

Actually, available data indicates that about 1 in 5 rural-based women give birth from their homes without presence of a skilled birth attendant.

Lifestyle characteristics including poor eating habits, inadequate physical exercises during pregnancies, worries about future sex-life and delayed childbirth, have also been put forward as key reasons for high C-section rates, especially among women in urban areas.

In an effort to avert this escalating problem, pregnant women should be advised on the effective management of their health while emphasising the risks of C-section births and benefits of natural labour.

In turn, incentives or allowances for medical personnel should be raised for successful natural childbirths handled and with extra supervision.

Mr Mukalazi is the Country Director of Every Child Ministries Uganda.
bmukalazi@ecmafrica.org

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