Women having trouble while they're giving birth can have their babies delivered by Caesarean section. But new research in the British journal The Lancet indicates that in much of the world, a woman's chance of having access to this medical procedure depends on her income.
Cynthia Stanton from the Johns Hopkins School of Public Health looked at about three years of data from 42 countries that recorded income statistics as well as information on Caesarean section rates. The numbers represented about half of the births taking place in developing countries. "In 20 of those countries," she notes, "women in the poorest 20 percent of households had Caesarean section rates of under 1 percent."
The World Health Organization recommends countries have a Caesarean - or C-section - rate between 5 and 15 percent. Stanton says there's an ongoing debate in the medical community about what rate is appropriate and adequate. She says there is agreement that when less than 1 percent of women have access to the operation, mothers and children are probably dying during childbirth.
She compares that to C-section rates at the other end of the economic spectrum. "In many of these same countries, you really see quite high C-section rates among the wealthiest 20 percent of the population. And so, for example, it was Caesarean section rates that were 5 times, 10 times, 25 times higher in the wealthiest groups as compared to the poorest. And in many of these countries, you see C-section rates of 20 percent, 30 percent, 40 percent, 50 percent… and then Brazil is always the outlier." The data shows that in Brazil, among the wealthiest women, the C-section rate is 67 percent. According to Stanton, rates that high are definitely in excess of medical need.
Many women choose to have a C-section - even though it is major abdominal surgery - because it can be scheduled and they perceive it to be more convenient. Stanton says high rates become a burden on health systems that might be struggling. "So to be doing C-sections in excess of medical need amongst the wealthy when you're not even keeping women alive among the poor…" she shakes her head in dismay. "Yes, there are health effects [on women] as well to be worried about, but certainly, there are effects on the health care system in very poor countries."
Stanton says when C-section rates get reported as a national average, the low rates among poor women are hidden in the statistics. She says this study shows that Caesarean section rates in poor countries should be reported along with income data to present a more complete picture.