Caesarian Section Rates in South Africa

Caesarean section rates in South Africa ‘recklessly high’, warn experts

Up to 90% of pregnant private hospital patients opt for C-section in parts of Cape Town, far exceeding WHO limit of 15%

South African caesarean section rates worry experts because the procedures are often based on convenience, not medical necessity.

More than two in three South African mothers in private hospitals give birth by caesarean section, way above the international average, research has shown.

Experts estimate that in wealthy areas 80% choose to have a caesarean, and in some hospitals in Cape Town the rate exceeds 90%, despite the cost being higher than the fee for a natural birth. The World Health Organisation (WHO) advises a maximum of 15% caesareans per country.

Figures released by South Africa’s Council for Medical Schemes showed that nearly 70% of births to women covered by a private medical scheme were by caesarean last year.

Jacques Snyman, clinical adviser to the Resolution Health Medical Scheme, told South Africa’s Times newspaper: “Caesarean sections have unfortunately become something of a ‘scourge’ for South African medical schemes. The international rate of caesarean sections is approximately 18%, making South Africa a large outlier in terms of international standards.

“The South African rates are concerning because caesarean sections have become elective procedures based on convenience instead of medical necessity. With caesarean sections the risk of premature delivery is high and complications can arise. Premature babies are more likely to land up in neonatal intensive care and suffer a host of problems.”

The rise in C-sections is a long-term global trend. A 2010 report by the WHO claimed the procedure had reached “epidemic proportions” in many countries and raised the risk of maternal complications. It found that nearly half of births in China were delivered by caesarean section, the world’s highest rate, and a quarter of these were not medically necessary. About a third of mothers in the US give birth by C-section.

While South Africa’s rate is significantly lower in public sector hospitals, a growing middle class who can afford to go private are increasingly taking the option. Lynette Denny, a gynaecology professor at the University of Cape Town, told the Times: “There are definite indications for a caesarean section, which can be life saving for both mother and child.

“But in some hospitals in Cape Town, the caesarean rate is over 90%. In my view, that is a dangerous, reckless practice. It is well known that having had a caesarean section puts women at risk for the next pregnancy.”

The data triggered debate in South Africa over why the figure is so high. Some experts suggest that in the event of a patient taking legal action, a gynaecologist needs to show they did everything they could, including a caesarean. The Times also noted: “Many people think the high rate of caesarean sections is thanks to gynaecologists who want to work on a Monday and play golf on a Friday.”

Article published The Guardian, Wednesday 24 September 2014


1 Comment

  1. Sally Levesque
    July 28, 2015

    As a women who had a C-section I take offence at the phrases:’patients opt for C-section’,’based on convenience’ and ‘choose to have a caesarean’.

    I completely agree that the C-section rate in South Africa is too high but I don’t think many women ‘choose’ to have a C-section. Of all the women I know who have given birth in the last few years I would say 90% of them have had C-sections. None of them ‘chose’ to have a C-section. Each of them went into labour (naturally or induced) and was later given a medically sound reason why an emergency C-section was necessary. I also don’t believe that the gynaes were doing C-sections for ‘convenience’. I believe that the gynaes did believe that all these C-section were medically necessary.

    The prevalence of C-sections is a self feeding loop – the more C-sections the doctors do, the more comfortable they are with C-sections and the less comfortable with vaginal birth and therefor the less likely to take a ‘risk’ when a ‘complication’ arises. I believe the only way to stop the cycle would be practical re-education of the doctors. The doctors are also victims of this system.

    I believe it is an over simplification to state that either doctor or mother ‘chooses’ a c-section. But it will take active choices by the mothers and the doctors to stop the cycle, and reduce the c-section rate.

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