The Global Epidemic of Unnecessary Cesarean Sections (Part 1)

Medical Daily

Cesarean section surgery, when medically indicated and performed by trained staff with the necessary equipment and supplies, can be a life-saving procedure for the mother and baby. However, compared to vaginal delivery, cesareans are associated with a higher risk of maternal and neonatal death; numerous maternal morbidities including infection, uterine rupture and amniotic fluid embolism; neonatal morbidities often related to iatrogenic prematurity; and potential complications in subsequent pregnancies. Studies have also observed that children born via cesarean are more likely to develop respiratory problems, diabetes and obesity later in life. Therefore, cesareans should be considered a major surgical intervention and only be performed when clinically necessary. 

Furthermore, to minimize the risks associated with cesarean section, the surgery should only be performed by skilled health workers in high quality facilities.

For many years, researchers have debated the optimal cesarean rate for maximizing maternal and infant health outcomes. Since 1985, the World Health Organization has estimated the ideal population-level cesarean rate at 10-15%, although some scientists have suggested a higher figure. Further investigation of an optimal rate is certainly warranted. Theoretically, the optimal population-level cesarean rate should be calculated based on the proportion of laboring women who have a medical indication for cesarean delivery. But, unfortunately, the high and increasing levels of cesarean delivery rates around the world illustrate that the procedure is not always medically indicated.

Clinicians sometimes disagree about what constitutes a medical indication, and in some cases lack the necessary tools to identify a complication. For example, fetal distress is a commonly reported reason for performing a cesarean—but how exactly does one measure fetal distress? How long should a provider wait for an abnormal fetal heartbeat to return to normal before deciding to perform a cesarean? How can clinicians in low-resource settings without access to fetal monitoring technology accurately assess these situations?

Before developing consensus on the optimal population-level rate, the global maternal health community must agree upon the medical indications for cesarean delivery and ensure that clinicians around the world are adhering to standardized, evidence-based guidelines.

This is the part one of a very interesting debate, please click here and here for part two and three .

News credit : Maternal Health Task Force Blog

Nigeria: Contraceptive Use Among Nigerian Women On Increase

The Federal Government's advocacy on the use of contraceptive among sexually active women in Nigeria for the prevention of unwanted pregnancy and abortion is beginning to yield positive results as more women are recorded to be embracing the method.

Compiled data from the 2015 report of the National Bureau of Statistics, NBS, on health shows that contraceptive use among sexually active women of child bearing age increased by seven per cent compared to 2014.

In 2014, 23 per cent of sexually active Nigerian women used contraceptives, while 30 per cent used in 2015, the Bureau's latest data showed.

Contraceptive are methods, devices or drugs used among sexually active people to reduce or prevent unwanted pregnancy and unsafe abortion.

A cross section of women interviewed in Abuja on family planning methods showed that most women engaged in one form of contraceptive method, either modern or traditional, to prevent unwanted pregnancy.

Aisha Jamiu, a plantain trader, said what she used to do to prevent pregnancy was count the days of her safe period with her husband and abstain from sex when she is not safe.

This is one of the traditional forms of contraceptive method to prevent pregnancy. The NBS data also showed a 2 per cent increase in use of traditional contraceptive methods between 2014 and 2015.

Read complete article here

News credit: Premium Times

Do Rwandans still need to travel abroad for child birth?

Photo: Newtimes

Rwanda has reduced both under-five mortality and maternal mortality by approximately three-quarters. This achievement has been attributed to improved maternal health care over the years. But despite this milestone, some women still prefer to travel out of the country to give birth.

Melisa Agasaro (not real name) delivered her first baby at a hospital in Australia and her second born in the US. Agasaro had a reason for choosing to travel far to give birth. She was diagnosed with a potentially life-threatening health condition, gestational diabetes, that couldn’t easily be dealt with in the country.

“I travelled to the US to have my second born in 2013, my pregnancy was a little bit complicated and the doctors here couldn’t trace the issue. When I went to the US, I was diagnosed with gestational diabetes, they also checked other complications but the condition was at a dangerous stage, so I was put on medication immediately,” the mother-of-two narrates.

She says she got outstanding care while in America.

Agasaro is just one of the many women who decide to have their babies abroad for various reasons. Some expecting women travel to give birth abroad as a matter of choice while others have no option since their condition cannot be managed locally.

For Lillian Mugabo, some women actually go abroad to give birth because of the way some local hospitals treat expectant mothers.

Referring to her experience, the mother of two supports women who choose to go abroad because she wouldn’t wish for any other woman to experience what she went through.

Mugabo had her second child two months ago, but the pain she experienced made her doubt the nurses who attended to her, and she wondered if they were skilled enough.

Vestine Uwamahoro echoes similar sentiments. She says that the process of giving birth is agonising enough and that a woman in labour deserves the best care from anywhere she believes she can get it.

“I wouldn’t say our system is bad, but I think those who go to other countries in most cases are seeking special care from more qualified doctors,” she says. 

Continue here to read more

News credit : The NewTimes

News: Zimbabwe: '20 Percent Zim Women Give Birth At Home'

About 20 percent of Zimbabwean births over the past five years occurred at home, statistics which experts have described as unacceptably high.

According to the recently-released Zimbabwe Demographic Health Survey (ZDHS), institutional deliveries stood at an average of 77 percent.

"Seventy-seven percent of live births in the five years before the survey took place in a health facility, while 20 percent were delivered at home. Most institutional deliveries took place at public sector health facilities," reads the report.

"In Zimbabwe, institutional deliveries declined from 72 percent in 1999, to 68 percent in 2005-06, and 65 percent in 2010-11, and then substantially increased to 77 percent in 2015.

"Over the same period, home deliveries increased from 23 percent in 1999, to 31 percent in 2005-06, and 34 percent in 2011-10, and then decreased notably to 20 percent in 2015."

The report shows that Bulawayo and Harare provinces had the most institutional births at about 91 percent. Midlands, Matabeleland South and Matabeleland North had high percentages ranging from 81 to 85 percent.

"Masvingo and Mashonaland East had institutional deliveries ranging from 71- 80 percent. Mashonaland West, Mashonaland Central and Manicaland recorded the least institutional births, ranging from 66 to 70 percent."

To read more click here

News credit : AllAfrica

Caring About Women’s Work: Why Sexual and Reproductive Rights Matter

The sexual and reproductive health and rights (SRHR) of women and girls are too often sidelined from key policy debates on women’s rights: dismissed as controversial and separate to discussions on women’s economic and political lives. Decision-makers and politicians silo different aspects of women and girls’ lives in policy initiatives, neatly separating rights related to bodily autonomy from workplace rights in ways that are neither realistic nor helpful.

The lives of women and girls are complex, varied and intersectional. SRHR cuts across every aspect of women and girls’ lives, both enabling and limiting life opportunities. The freedom to decide if and when we marry and have children, to live free from violence, and to make decisions regarding our bodies are key to empowering women economically.

Despite this trend, it is important to look behind the numbers, and assess the extent to which women's work is empowering. ‘Women’s economic empowerment’ is a term that has come to mean everything and nothing in policy terms, not only because the concept of ‘empowerment’ is so difficult to measure. Rather than view women’s economic empowerment solely within the prism of economic growth, we must unpack the complex systems that uphold women’s inequality, and avoid falling into the trap of assuming women’s formal labour force participation and contribution to the market economy is necessarily empowering. We must instead look at how our current economic models uphold women’s inequality and identify where women work and why they work, as well as the quality of their working conditions.

Women’s work

Much of women’s work remains hidden and unpaid. A major reason for this is that women around the world are disproportionately responsible for undertaking care work. Care work is mostly unpaid labour undertaken by women and girls such as child care, elder care, taking care of ill family members, cooking and cleaning.  The ‘care economy’, which includes paid and unpaid care work and is primarily undertaken by women and girls, and has an impact on their life opportunities outside of the home. Continue here to read more

News credit: Womendeliver