Cesarean deliveries ratio high in urban areas: PIDE research

KARACHI: Cesarean section (C section) is a major surgical procedure that surely has medical justifications behind its induction. Overall the C section deliveries are 16 percent in Pakistan which shows a slightly above prevalence to recommended 15 percent rate, according to Pakistan Institute of Development Economics’ (PIDE) research report.

However, this figure for urban areas of Pakistan does not turn out encouraging i.e. about 26 percent deliveries are done via C section. It is easily predictable that the rate of C section would be high in urban areas than rural ones, as there medical facilities regarding maternal care are available to target population, and our findings are just as expected.

In the provinces of Punjab and Sindh, C section rates in urban areas are found at higher end around 27 percent as compared to rural areas where these have been found 1 5 and 10 percent respectively. KP and Balochistan show much low rates than Punjab and Sindh, especially in Balochistan where it seems that institutional maternal care is extremely at lower limit. The rate of C section deliveries in rural areas of Balochistan and KP are drastically low, 1.433 and 3.63 respectively.

This also probably indicates both the unavailability of medical infrastructure and at the same time low utilization of maternal care by t he population. Low rate of C section also has been found for in rural GB. One of the most interesting figures came out for Islamabad, where C section deliveries are as higher as goes to 33 percent for urban and 23 percent for rural region. These sky high rates in capital city of the country may be due to easy access of medical infrastructure both public and private and socio – economic profile of the population.

In many studies it is found that women who are from better socio-economic background would have higher rates for C section deliveries. We have also found that there is a marked difference of 30 percentage point among poorest and richest income quintiles in C section rates. There is an increasing trend of C section deliveries from poorest to richest quintiles. The richer and richest quintiles women have 23 and 35 percent C section deliveries as compare to women from the other three quintiles where this rate are lower than 12 percent.

The same trend has been found in case of educational profile of women. We have found higher C section rates for the highly educated women than women with low education. In fact, low preference/utilisat ion of C section has been found for women with no education category, where this rate is 7.5. At the same time, women with matric, secondary and higher education show alarming percentages of C section with 21, 31 and 43 percent respectively utilization of private maternal medical care is high in Pakistan and women belonging to better socio – economic background are presumed to avail private facilities more due to the affordability factor, which open up possibility of higher C section rates in these facilities.

As from the previous discussion, we have found that women living in urban areas, having high income background, and from higher education profile have higher levels of C section rates. It is possible that private facilities may have higher rates of C section than public ones because the nexus of income, education and area of residence that somehow explains the decision making power of women to go for C section without having any medical complication. On the other hand, that also explains exploitation of this population group by the private maternal care facilities to make money out of unnecessary intervention of C section.

We have not found any remarkable difference in C section rates between public and private facilities both in urban and rural areas. In urban areas C section rates in both facilities are almost same about 35 percent in pubic and 36 percent in private hospitals. Whereas in rural area this difference is only about 4 percentage point. The high rates of C section rates in public hospitals are often justified by the high number of referrals in these hospitals from the periphery medical facilities. But the high rates o f C section in private facilities is somehow not justifiable as only those patients go into these facilities who can afford the huge charges of maternal care.