High rate of caesarean sections seen in Latin America -- but is this the preference of women or healthcare workers?

November 25, 1999

Rates and implications of caesarean sections in Latin America: ecological study

Commentary: all women should have a choice

Commentary: increase in caesarean sections may reflect medical control not women's choice

Commentary: "health has become secondary to a sexually attractive body"

Click below to download PDF document
You will require Acrobat Reader to view file.
Click here for PDF document

Rates of caesarean births are high in the majority of Latin American countries, which is leading to an unnecessary increased risk for young women and their babies, claim researchers in this week's BMJ. Dr Jos Belizn and colleagues from the World Health Organisation in Uruguay also observe a link between the level of caesareans within the richer countries and among more affluent women. Commentators on the study argue that the reasons behind the high level of caesarean sections in this part of the world may be because this method of birth is more "convenient" for healthcare workers or because women believe that a caesarean section will leave them with a more "sexually attractive body" than a vaginal birth.

Dr Jos Belizn and colleagues from the World Health Organisation (WHO) in Uruguay studied births in 19 Latin American countries and estimate that in twelve of these, caesarean section rates range between 16.8 and 40 per cent of births (the WHO recommended in 1985 that caesareans should account for no more than 15 per cent of all births). Based on their estimates of national caesarean section rates, the authors calculate that 850,000 unnecessary caesareans are performed each year in the region and that concerted action from public health authorities, medical associations, medical schools, health professionals and the media are needed to reduce the rates.

But why shouldn't women "side-step their biblical sentence to painful childbirth?", ask Professor Elaine Showalter and Anne Griffin from Princeton University in an accompanying editorial. They argue that the biggest issue surrounding caesarean births is not that wealthier women are having more but that women in underdeveloped countries are being denied the option. Showalter and Griffin also claim that the WHO guidelines of 15 per cent for national caesarean section rates are "arbitrarily chosen and need to be reviewed" and that "women's equal access to quality medical services should be our central concern".

In a separate commentary Dr Arachu Castro from Harvard School of Public Health writes that "the systematic use of medical technology, justified by the idea that a woman's body is not capable of giving birth without medical intervention, seems to be more directed towards the convenience of healthcare professionals than the benefit of the women in labour". She argues that by having a woman in a horizontal position, connected to a hormone drip, having undergone epidural anaesthesia and wired up to an electronic fetal monitor "creates the impression that she is being taken care of". On the contrary, Castro says, women tend to perceive such an experience as painful, frightening and confusing and she concludes that women should be given back the central role in childbirth and that new guidelines restricting the use of caesarean sections while improving the quality of care should be welcomed.

The reason behind the high rates of caesarean sections among Latin American women is that they want to avoid genital damage, because "health has become secondary to...a sexually attractive body" argues Hilda Bastian a consumer health advocate from Australia in a third commentary on Belizn et al's paper. She fears that the "fashion" for caesarean sections could grow in to "something far worse" and just as when upper class women in the last century abandoned breast feeding it will be the poorer families who pay the cost of this trend.
-end-
Contact:

Dr Jos Belizn, Director, Latin American Centre for Perinatology, Pan American Health Organisation, World Health Organisation, Montevideo, Uruguay

Tel: 598-2-487-2929 x57
Fax: 598-2-487-2593
Email: belizanj@clap.ops-oms.org

Professor Elaine Showalter, Professor of English, Princeton University Department of English, Prinecton, USA

Tel: 609-258-4072 or 609-924-0832 (25th and 26th)
Email: 112075.445@compuserve.com

Dr Arachu Castro, Research Associate, Department of Population and International Health, Harvard School of Public Health, USA Tel: 617-661-6679
Email: acastro@hsph.harvard.edu

Hilda Bastian, Consumer health advocate, Blackwood, Australia

Tel: 61-8-8278-5272 or Mobile: 61-413-802-374
Email: hilda.bastian@flinders.edu.au

BMJ

Related Caesarean Section Articles from Brightsurf:

Risk of childhood asthma by caesarean section is mediated through the early gut microbiome
New study highlights long-term perturbations of the early gut microbiome as a possible mechanism for the observed association between caesarean section and increased risk of developing asthma.

During COVID-19 first wave, the proportion of caesarean section deliveries done under
New research from north-west England published in Anaesthesia (a journal of the Association of Anaesthetists) shows that during the first wave of COVID-19, the proportion of caesarean section deliveries carried out under general anaesthesia approximately halved, from 7.7% to 3.7%.

Caesarean birth, prolonged labour influence infant gut bacteria, risk of childhood obesity
Events at birth may affect the microbes living in a baby's gut during the first few months of life, leading to a higher risk of childhood obesity and allergies, according to a new study published in the journal Gastroenterology.

Fecal transplantation can restore the gut microbiota of C-section babies
Birth by Cesarean section is detrimental to normal gut microbiota development.

Women who deliver by C-section are less likely to conceive subsequent children
Women who deliver their first child by cesarean section (C-section) are less likely to conceive a second child than those who deliver vaginally, despite being just as likely to plan a subsequent pregnancy, according to Penn State College of Medicine researchers.

Caesarean birth has little impact on children developing allergies
A caesarean birth had little impact on whether a child would go onto develop allergies, a new study has shown.

Different views on vaginal birth after previous caesarean section (VBAC)
There is considerable variations in different countries┬┤ health care systems and professionals in the views on vaginal birth after previous caesarean section (VBAC), according to a European study.

Outcomes of birth options after a previous cesarean section
A large cohort study of women who have had one or more previous cesarean sections suggests that attempting a vaginal birth in a subsequent pregnancy is associated with higher health risks to both the mother and the infant than electing for another cesarean.

Death rates from cesarean section far higher in developing countries
Cesarean sections are disproportionately threatening the lives of women and babies in low and middle-income countries (LMIC), according to a study led by Queen Mary University of London.

Altered microbiome after caesarean section impacts baby's immune system
Together with colleagues from Sweden and Luxembourg, scientists from the Luxembourg Centre for Systems Biomedicine (LCSB) of the University of Luxembourg have observed that, during a natural vaginal birth, specific bacteria from the mother's gut are passed on to the baby and stimulate the baby's immune responses.

Read More: Caesarean Section News and Caesarean Section Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.