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Cesarean delivery on dramatic rise in Ethiopia

A number of research outputs and medical reports are indicating an alarming level of increase in the overall rate of Cesarean deliveries a.k.a “C-sections” in Ethiopia with the procedure becoming more prevalent in private health institutions (as high as 46 percent of all deliveries) in Addis Ababa and other urban areas of the country.

A recent nation review of cesarean deliveries in Ethiopia, conducted by Nebreed Fesseha, Atnafu Getachew, Mihret Hiluf and Yirgu Gebrehiwot and published in the International Journal of Gynecology and Obstetrics, researched some 797 facilities in the country using a record view of 267 cesarean deliveries based on the last 3 performed in each facility and a 12-month summary of each facility’s statistic on vaginal and abdominal deliveries.

The research, hence, found out that the overall institutional rate of cesarean delivery was at 18 percent in Ethiopia, varying between 46 and 15 percent in the private for profit sector and the public sector, respectively.

Meanwhile, another research, conducted by Samson Gebremedhin from the Hawassa University School of Public and Environmental Health, also indicated that “C-section” rate has increased significantly in Ethiopia in the past 15 years, rising from 2.3 percent in 1995–1996 to 24.4 percent in 2009–2010. From 2003 onwards, it persisted above 15%, the research stated.

Furthermore, the research looked at the socio-economic aspect of the specific medial services and found out that “C-section” among women from high income households (28.6 percent) was higher than those from the low income (16.4 percent) and middle income (19.5 percent) families.

The use of surgery to deliver babies has been prevalent for many centuries; it was perfected in the early 20th century with the use of antibiotics and anesthesia.

The procedure is common during childbirth when the mother or the child is in distress and vaginal childbirth is not advisable for the safety of either. The 45 minute long procedure requires a longer recovery period for mothers that can take as long as six weeks. Although the procedure is only taken when vaginal delivery poses risk for the mother or the child, some mothers have been known to request “C-sections” for personal or social reasons. Many health professionals are supposed to recommend counseling to identify the reason for the request and most encourage vaginal births.   

The procedure costs thousands of birr in private hospitals in Addis Ababa and longer stays in hospital wards during recovery can hike up the costs even higher. Obstetricians have been known to offer and recommend the procedure to expecting mothers even under circumstances where natural childbirth is a viable option.

There has been a global rise in “C-section” birth where the rate doubled from 2003 to 2018 to reach 21 percent, and is increasing annually by 4 percent.

The World Health Organization (WHO) has abandoned its recommendation of 15 percent nationwide cesarean section rates, recommending women in need of the procedure should have access to it.

The International Journal of Gynecology and Obstetrics research further recommended “a need to monitor the appropriateness of obstetric care in all sectors and to increase access in rural areas. Clinical management protocols for obstetric and newborn care are needed, and audits of cesareans should be performed at all institutions, especially in the private sector.”