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DATA BRIEFS (continued)

Lack of obstetric care: Mothers and babies at risk

Caesarean sections are but one of a range of maternal health care interventions needed to save the lives of women and their babies and ensure that women's right to health care is fulfilled. Necessary measures include regular pre- and post-natal health care, skilled care during labour and delivery, adequate nutrition and rest, and care and support within the family, as well as emergency obstetric services. Every year, approximately 600,000 women die and another 15 million endure painful, debilitating, often permanent injuries resulting from pregnancy and childbirth.

C-section rates are one of the few indicators for measuring women's access to obstetric care for which data are widely available. But access to C-sections for women who need them represents only a fraction of women's total need for obstetric care.

Based on research and analysis, WHO has determined that the rate of C-sections in a given population should be no less than 5% and no more than 15% of all pregnancies if the lives of women and infants are to be protected.

Rates below 5% are clear and grave warnings that many women and babies are dying because of inadequate access to the whole spectrum of obstetric services. Rates above 15% indicate an unnecessarily high reliance on a major surgical procedure with numerous risks. It is essential that C-sections be performed only when necessary and in facilities that are adequately equipped and staffed to ensure safety.

Among the 33 countries listed, C-section rates in rural areas fall into the danger zone of less than 5%. In 15 of these countries, rates in urban areas are also below this percentage. In Chad and Madagascar, the level of obstetric care is critically low, with C-section rates of nearly zero in rural areas and only 1% and 2% respectively in urban areas.

Initiatives in several countries are helping to improve access to obstetric services. In Viet Nam, community networks help women with obstetric complications reach medical services quickly. Similarly, communities are sharing costs to improve referral systems for complications in Benin, Ghana, Mali, Nigeria, Senegal and Tanzania. Efforts such as these are essential for progress towards the goal of halving maternal mortality rates between 1990 and 2000.

At the same time, some countries with high C-section rates, such as Brazil (with 42% in urban areas) and the United States (21% nationally), have flagged the high rates as a problem to be addressed.