Global rates of cesarean section use almost doubled between 2000 and 2015, a study has found, with many surgeries being performed without any significant maternal or birth-related benefits.

C-sections can save the lives of women and babies when there are birth complications such as fetal distress, or abnormal positioning. However, the research published in The Lancet medical journal suggests overuse of the surgery can lead to considerable short and long-term effects and health-care costs.

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Experts estimate between 10 and 15 percent of births medically require a caesarean section. However, researchers calculated that, while in 2000 some 12 percent of births were performed using a C-section, the percentage had risen to 21 by 2015.

Geographic differences

Drawing on World Health Organization and UNICEF data from 169 countries, the research uncovered large discrepancies between geographical regions, with 60 percent of countries overusing C-sections and 25 percent under-using them.

In at least 15 countries, more than 40 percent of births were performed using a C-section, with the Dominican Republic topping the list with 58.1 percent of all babies delivered using the procedure.

More than half of all births are carried out with C-section in Brazil, Egypt and Turkey, while in parts the west and central Africa region the procedure was used in only 4.1 percent of births.

Socio-economic factors

There were not only different C-section rates between countries but also within them according to women's socio-economic status and access to medical facilities.

For example, in China, C-section rates ranged from 4 percent to 62 percent, while in India the range was 7 to 49 percent.

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Wealthier, educated women in urban areas with better access to medical facilities tend to have much higher C-section rates even when they were at low obstetric risk, the research found.

In low and medium-income countries, C-sections were almost five times more frequent in births among the richest quintile versus the poorest quintile.

"The wide variations reported between regions, within countries, and between groups of women confirm that cesarean section use is not evidence-based," The Lancet wrote in an editorial piece accompanying the research, calling overuse of the operation an "epidemic.”

"The large increases in C-section use – mostly in richer settings for non-medical purposes – are concerning because of the associated risks for women and children," said Marleen Temmerman, an expert from Aga Khan University in Kenya and Ghent University in Belgium who co-led the research.

Dangers and motivations

C-sections can lead higher risks for future births, including scarring of the womb, uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth. There is also emerging evidence the procedure can have an impact on baby hormonal, physical and immune development. In the absence of proper healthcare facilities and skills, women and their infants can even die from the procedure.

The research suggested some women are motivated to have medically unnecessary C-sections because of previous negative experiences with vaginal birth, fear, pain relief or concerns about incontinence and reduced sexual function.

It has also become "fashionable" and considered "modern” or safer to have a C-section in some countries, the research said.

There is an urgent need for intervention in the medical field to reduce the use of cesarean sections, the researchers said.

The authors suggested women be provided with more information and consultations about C-sections. They also advocated for increasing midwifery care and ensuring doctors are making evidence-based decisions to use C-sections.

cw/rc (AFP, Reuters)

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