By Mukhtar Alam

KARACHI: Percentage of women in 15-49 years age group, who delivered a child through caesarean section (C-section) –a cut made in the mother’s abdomen and uterus—registered an increase of almost 25 per cent in Sindh by 2018, according to the findings of Multi Indicators Cluster Survey (MICS) 2018-19.

Overall, 21.9% of women, who delivered in the last two years before they were accessed for the survey, had C-sections –for 14.9% of the women, the decision was taken before the onset of labour pain and for 7% after.  The proportion of C-section deliveries in the total births was found 17.8% in MICS 2014 report – for 11% the decision was taken before the onset of labour pain.

The surveyors found that C-section prevalence was maximum (43.8%) in pregnant women who ensured frequent –eight-plus—antenatal visits to health facilities.

According to the latest report of MICS undertaken by the Sindh Bureau of Statistics, in collaboration with Unicef, and completed over two years back, 31% of women who had C-sections were living in urban areas, while 14.6% were housed in rural settings.

MICS report, which has been made available online lately, says that 22.3% of such births occurred in public sector health facilities, while 38.8% took place at privately run hospitals and maternity homes.

The rate of women given C-section intervention was found maximum i.e. 23.4% among women of 20-34 years ago, followed by those of 35-49 years (18%) and less than 20 years (16.1%).

In the meantime, when Social Track contacted a senior reproductive health expert, Dr Samrina Hashmi, for her views on the reported trend of C-section in the province, she underlined the role of midwives, saying: “Our maternity facilities should be managed by midwives, dedicated to the patient care”.

According to her, the drawback of maternity facilities based only on lady doctors or consultants was that they have been unable to allocate sufficient time to mothers-to-be. “The lady doctors use to practice in two or three hospitals. Most of the time they finish the cases in one setup before moving to the next setup,” she said while noting that in case maternity set-ups were run by midwives, the consultants could only be called when there occurs obstruction during labour or needed intervention.

Discussing the subject at length, Dr Hashmi, also a former leader of the Pakistan Medical Association, said that both vaginal delivery and C-sections come with risks and potential complications.

WHO: Separately, World Health Organisation (WHO) has once again stressed the need for avoiding overuse of the procedure as it can put women and babies at unnecessary risks.

According to new research from WHO, C-section use continues to rise globally, now accounting for more than 1 in 5 (21%) of all childbirths. “This number is set to continue increasing over the coming decade, with nearly a third (29%) of all births likely to take place by C-section by 2030,” the research finds.

WHO Director of Department of Sexual and Reproductive Health and Research and the UN joint programme, HRP, Dr Lan Askew stated that caesarean sections were absolutely critical to save lives in situations where vaginal deliveries would pose risks, so all health systems must ensure timely access for all women when needed.

“But not all the caesarean sections carried out at the moment are needed for medical reasons. Unnecessary surgical procedures can be harmful, both for a woman and her baby.”