Caesarean section is one of the most common and life saving surgical procedures for delivering a baby in case of complications. The World Health Organization (WHO) recommends a CS rate of 10-15%. Unnecessary excessive use of CS can be fatal for both mother and child. In addition, the procedure can cause adverse effects in subsequent pregnancy like stillbirth, placenta previa, and miscarriage. CS can have many other short term and long term effects on maternal and child health.
The CS rate is inclining in Nepal and as expected, the rate is significantly higher in urban areas than in the rural parts of Nepal. The Nepal government promotes maternal health and institutional deliveries including C sections when necessary but faces challenges with rising unnecessary CS rates especially in the private hospitals.
Rising Caesarean Section Rates in Urban Nepal: Is Motherhood Safe?
Nepal has made substantial progress in transitioning deliveries from homes to medical facilities within the previous two decades. As per the reports, 87.6% of the children were born at home compared to 18.7% by 2022. With the context of being modernized, it seems that motherhood has a serious risk to pay.
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| Source: Venus IVF |
Nepal’s C-section rate has increased over time from 0.9% in 2001 to 18.2% in 2022 showing a 20-fold increase in twenty years. A public health official at the Family Welfare Division of the Department of Health Services Nisha Joshi stated,
“As per the World Health Organization, up to 10 to 15 percent of C-section deliveries in the general population is normal, but our C-section delivery rate is 18 percent in the general population.”
“The C-section delivery rate at private hospitals is several times higher than that of state-run hospitals.”
While CS are a lifesaving invention in case of medical emergencies for both mother and newborns in case of serious complications, particularly high CS rate signifies that a substantial portion are likely not medically necessary. The use of CS without a need can place women at risk of short term and long term health issues.
As per the reports 51% of babies were delivered via CS in private hospitals whereas 15% of the births in public run hospitals. Health ministry officials claim that the C section delivery rate in big cities like Kathmandu Valley is around 90%.
Joshi added,
“Private hospitals have their own explanations about the higher number of C section deliveries, We cannot prevent hospitals from carrying out C section delivery, and the hospitals say all C section deliveries were performed due to complications.”
Studies show that the C section delivery rate in urban areas is 22% while it is 12% in the rural areas.
Dr. Ganesh Dangal, chairman of the Nepal Society of Obstetricians and Gynecologists said,
“C section delivery rate is alarmingly high at private hospitals. Authorities concerned should continue monitoring and discourage unnecessary surgeries.”
Nepal’s Maternal Mortality Ratio (MMR) has significantly decreased with recent estimates around 142-151 deaths per 100,000 in 2022-2023 which decreased from much higher figures like 539 in 1996. Further, the UN’s Sustainable Development aims to reduce maternal mortality rate to 75 for every 100,000 births by 2030.
Possible Driving Factors of Increasing CS in Nepal
Increasing C section rates in Nepal are driven by several socioeconomic factors (like education, urban living, wealth), individual choices (family pressure, fear of pain, assumption of safety, older maternal age), provider incentives (medico legal and financial),lack of awareness, misguidance, and inadequate guidelines.
Reports suggest that doctors in Nepal, particularly in private urban hospitals are involved in excessive use of CS delivery. Their decision can be driven by financial incentives, lack of pain relief options for normal delivery, and possible patient demand. Private hospitals benefit financially as CS generate more revenue than normal deliveries with an increased cost in the procedure and medications.
One of the victim trapped in the private hospital's dirty business said,
“I suspected foul play but couldn’t have done anything. I had to agree to an operation.”
She added,
“Even if I plan for a second baby, I will not go to a private hospital.”
“Attending doctors had convinced me that I could have a normal delivery but at the last hour, they decided to operate on me.”
“I was beginning to go into labour pain when I was rushed into OT.”
Policy changes, better training, increased awareness, focusing on equal fees for vaginal and CS births, publishing hospital rates, and expanding skilled birth attendance (SBAs) for natural deliveries could be some important measures to shift the trend of unnecessary CS procedures.
If the government mandates equal fees for hospitals and doctors for vaginal and CS delivery, it could remove the financial incentives for surgeries. Transparency of all the CS and norman delivery rates of hospitals and implementing sanctions for hospitals failing to meet targets could be some of the possible ways to divert the trend.
