Born to die: study flags Africa’s huge C-section death rate
African women are 50 times more likely to die from the surgery, a tragic scenario made worse by delayed medical care and a shortage of specialists
African women who give birth via caesarean section are 50 times more likely to die from the surgery compared with their counterparts in first-world countries, a new SA study has revealed.
The study, published on Friday in The Lancet, found that not only are women from the continent likely to have complicated pregnancies, but delayed medical care and a shortage of specialists are resulting in avoidable deaths.
About 3,500 women from 22 countries, including SA, formed part of the study by the University of Cape Town, which was funded by the Medical Research Council.
At more than 180 tertiary hospitals, mainly in the public health sector, women with placental problems, a ruptured uterus, bleeding before birth and anaesthesic complications were more likely to die after a caesarean delivery.
About three out of four deliveries were emergencies, suggesting that many more mothers could be dying before they make it to healthcare centres.
Their babies were more likely to die, too, as their mothers are often sick when they give birth. The latest study found that the neonatal mortality rate within the first month of life after a caesarean section in Africa is double the global average.
One in every six pregnant women on the continent developed complications during surgery – about six times higher than high-income countries.
Lead researcher Prof Bruce Biccard said while high-income countries were overdoing C-sections, the life-saving surgery was under-used in Africa. Even so, it accounts for one in three of all operations on the continent.
Biccard said it was the lack of other surgeries in African hospitals that made C-sections appear common.
“The reality is that we are not performing enough C-sections to save lives. If we were doing more surgeries in other disciplines, C-section would actually look small. There are a lot of mothers out there that would require C-sections, but are being missed and end up dying as a result,” he said.
Biccard said the latest findings also showed the impact that poor human resources or lack of specialists had on maternal health.
While high-income countries had about 20 specialists for every 100,000 births, in Africa the ratio was 0.7:100,000. Hospitals surveyed had an average of three specialist obstetricians, three specialist surgeons and two specialist anaesthetists.
Almost one in four women received anaesthesia from a non-specialist, and about 10% of the recorded deaths happened after anaesthesia complications.
Biccard said while it would take an increase in specialists of at least 20-fold to improve the outcomes, other interventions could improve the situation within current resources.
Areas that should be targeted include early risk of bleeding especially where availability of blood is low; and improvement of access to blood and blood products with long shelf-lives. He and his co-authors also highlighted the need for safer anaesthesia during caesarean deliveries.