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"
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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.
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