Upsurge of caesarean sections in Pakistan: A qualitative study on perceptions of women and gynaecologists (original) (raw)
Related papers
Local Perception about Caesarian Section among Post Caesarian Section Women in Pakistan
Birthing is a critical moment in the life of a mother. The biomedical practice of the Caesarian Section (C-section) does not exist in a vacuum but is under the influence of the sociocultural environment. However, deciding between methods of birth and the perception about the C-section shows a gap and dearth in the present literature. This paper aims at understanding what social and cultural factors construct the perceptions and experiences of the Caesarian Section among post-C-section-women belonging to different socioeconomic statuses. Moreover, it explores how these factors influence Pakistani women"s decision-making regarding childbirth methods. The paper uses a qualitative yet multi-sited locale approach, employing semi-structured interviews from 20 post-C-section women mainly from Islamabad and Rawalpindi region; 10 women belong to lower socioeconomic status whereas, 10 to the upper one. Different themes from data were identified and obtained for analysis. The perception and experience of the C-section fluctuate with social, economic, and cultural factors. The influence of biomedical and intra-household politics on the decision of C-section is much conspicuous and evident. Affluent families practice C-sections under dominant power dynamics without any reasoning. For those who can afford C-section, is perceived as a luxury and artificial motherhood in the eyes of ""the others"" whereas, normal birthing was true and natural motherhood. The social construction of the C-section suggests that social and cultural forces play a decisive role.
Hospital practice (1995), 2017
There is increasing prevalence of caesarean sections (CS) worldwide; however, there are concerns about their rates in some countries, including potential fears. Consequently, we aimed to determine the frequency of CS, and explore patient's perception towards CS attending public hospitals in Pakistan, to provide future guidance. A two-phased study design (retrospective and cross sectional) was adopted. A retrospective study was conducted to assess the frequency of CS over one year among four public hospitals. A cross sectional study was subsequently conducted to determine patients' perception towards CS attending the four tertiary care public hospitals in Quetta city, Pakistan, which is where most births take place. Overall prevalence of CS was 13.1% across the four hospitals. 728 patients were approached and 717 responded to the survey. Although 78.8% perceived CS as dangerous, influenced by education (p=0.004), locality (p=0.001) and employment status (p=0.001), 74.5% of pa...
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Caesarean section is life-saving, but rising rates are a cause for concern. Perceptions surrounding caesarean delivery may play a significant role in the shared-decision making process. Objective of this study was to explore the perceptions of caesarean section among antenatal, postnatal women and healthcare providers in a rural maternity hospital in Ramanagara district, Karnataka.Methods: Qualitative research methodology was adopted to explore perceptions regarding preferred birthing mode, caesarean and its perceived complications. Focus group discussions and in-depth interviews were conducted with antenatal and postnatal women, their caregivers and health care providers. Inductive coding approach and thematic framework analysis was done.Results: Five major themes emerged regarding perceptions of caesarean section among women in a rural area of Karnataka: understanding, fears, decision making, after-care and prevention. Women had a strong preference for normal vaginal b...
The Factors Influencing Cesarean - Section Rates - A Narrative Review from Pakistan
The Journal of medical research, 2021
The significant increase in the rate of cesarean section is a major public health issue. The World Health Organization recommends C-section rates not to be greater than 10% and not lower than 5% as both the indicated limits can adversely affect maternal and newborn health. The rate of C-section deliveries is 22% according to recent Pakistan demographics and Health Survey of 2017-2018. This study contributes to the existing literature by examining the factors influencing high C-section rates in Pakistan. A narrative review of published literature between 2000 to 2020, on "factors influencing C-section rates in Pakistan" was done. The findings highlighted five factors that primarily influence utilization of C-section which include: 1. Accessibility to utilize C-section, 2. Association of C-section rates with socioeconomic profile, 3. Elective C-section, 4. Medical conditions as a cause of C-section, 5. C-section as a source of business. Pakistan like other Low middle income countries (LMICs) is facing the increased disease burden on its week and fragile health system. The over utilization of C-section rates has imposed additional burden on the health care system of Pakistan as well as increased economic and health resource liability on maternal care.
Journal of Biosocial Science
Access to Caesarean section (C-section) remains inadequate for some groups of women while others have worryingly high rates. Understanding differential receipt demands exploration of the socio-cultural, and political economic, characteristics of the health systems that produce them. This extensive institutional ethnography investigated under- and over-receipt of C-section in two rural districts in Pakistan – Jhelum and Layyah. Data were collected between November and July 2013 using semi-structured interviews from a randomly selected sample of 11 physicians, 38 community midwives, 18 Lady Health Visitors and nurses and 15 Traditional Birth Attendants. In addition, 78 mothers, 35 husbands and 23 older women were interviewed. The understandings of birth by C-section held by women and their family members were heavily shaped by gendered constructions of womanhood, patient–provider power differentials and financial constraints. They considered C-section an expensive and risky procedure,...
The Journal of medical research, 2021
Background: Caesarean section was one of the major issues in worldwide both in developed and developing countries. In Punjab, high prevalence of C-section had been perceived. Objective: To assess the prevalence, socio-demographic and socioeconomic factors of caesarean section in the Punjab. Methodology: The study was based on the data of Multiple Indicators Cluster Survey 2017-18 (MICS Punjab). Two-stage, stratified cluster sampling technique was adopted. Almost 53,840 households were selected to obtain the data from Punjab. Target population was currently and ever married women (15,656) who have given birth in last two years. From these women, a question was asked whether the delivery was normal or by C-section. We gave value 1 if delivered by C-section and 2 otherwise by using the Statistical Package for Social Sciences (SPSS) version 23. Results: The prevalence of C-section was 28.9% in the Punjab with 95% C.I (28.9%, 29.7%) and odds ratio (OR) 3.13. Out of ten, three women delivered baby by C-section. Area of residence, number of antenatal care visits, mother's age at time of marriage, education, wealth index quintile, and tetanus toxoid injection during last pregnancy were highly associated with the C-section. Educated and rich women were more attracted to deliver by C-section as compare to a women who were uneducated and belonged to poor socioeconomic group. In Central Punjab higher cases were found as compare to the South Punjab and Northern Punjab. Conclusion: The prevalence of C-sections is very high in Punjab when compared with WHO standard. The contributing factors to this rising trend of increased rate of C-section, higher education, improvement of socioeconomic status and easy accessibility of C-section facilities.
International Journal of Environmental Research and Public Health, 2021
The increasing frequency of cesarean section (CS) is a major public health issue, and it is on the rise in Pakistan. A cross-sectional study approach was used to assess the frequency of CS and its contributing factors, along with the assessment of knowledge in mothers who had undergone CS in one of the under-developed regions of Pakistan. Data collection was done by using a self-developed study questionnaire. The statistical package for social sciences (SPSS) was utilized for the statistical analysis. During the study period, a total of 173 (69.7%) women have given births by CS; among those, 104 (60.1%) were elective/planned CSs while 69 (39.8%) were emergency CSs. The higher CS frequency was significantly associated with younger age (p = 0.03) and pre-term gestational age (p < 0.001). Pregnancy complications, such as gestational diabetes, hypertension, preeclampsia/eclampsia, and vaginal bleeding, were the significant risk factors for CS (p < 0.001). The highlighted contribut...
Trends of cesarian section , 2018
Background: Pakistan is among those countries where the number of caesarean section births has increased unusually in the past two decades. Therefore, the aim of the present study is to analyse the trend of caesarean section deliveries among child-bearing women (aged 15-49 years) in Pakistan and to identify maternal sociodemographic factors and pregnancy-related variables associated with the change in caesarean deliveries from 1990 to 2018. Methods: Secondary data from Pakistan Demographic and Health Surveys (1990-2018) were analysed. The analysis of data was confined to child-bearing mothers. Sample sizes were 4029, 5721, 7461 and 8287 for the time periods of 1990-91, 2006-07, 2012-13 and 2017-18, respectively. Socio-demographic information of the mothers and pregnancy-related variables were taken as independent variables for the present study. The association between independent variables and caesarean deliveries was measured in terms of unadjusted odds ratios (OR) and adjusted OR (AOR). Results: The percentages of the mothers who had at least one delivery during the 5 years prior to each survey who had caesarean deliveries increased continuously from 3.2% in 1990-91 to 19.6% in 2017-18. Results indicate that mothers over 24 years of age, located in Punjab, from the richest socioeconomic class and living in urban areas were more likely to have delivered by caesarean section. Mothers with a first child in birth order and who had five and more children, as well as mothers who had more antenatal care visits and delivered babies in private hospitals showed a higher probability of caesarean section births.
Prevalence and determinants of Caesarean delivery in Punjab, Pakistan
Eastern Mediterranean Health Journal, 2018
especially in developing countries (5). As a reference, the World Health Organization, in its 1985 report, suggested an optimal range for C-section rates of 5-15% (6). Many studies have found that the likelihood of delivery through C-section depends on a number of institutional, demographic and socioeconomic factors. The availability of facilities, obstetricians and the place of birth, that is, private or public sector institutions, is associated with C-section rate (7,8). C-section is significantly associated with multiple conception, maternal age at birth, rise in institutional deliveries, number of previous deliveries, site of prenatal care (private or public), socioeconomic status of household and access to antenatal care (9-11). Some maternal characteristics such as education and access to antenatal care are also strongly associated with the likelihood of C-section (4,10,12). In view of the recent understanding about the factors associated with C-section, this study identified a set of socioeconomic, demographic, spatial and institutional indicators associated with C-section delivery. We used data from the Multiple Indicator Cluster Survey (MICS)
Rising Rate of Caesarean Section – A Global Problem
International Journal of Current Research and Academic Review
Article Info To compare the frequency of Caesarean Section (CS), Emergency and Elective CS, indications of Emergency and Elective CS and obstetrician reasons for supporting women choice for caesarian section between a healthcare setting of Saudi Arabia and Pakistan. The retrospective study analyzed the hospital records of all deliveries during the period January, 2012 till December, 2012 at two settings, Muhammad Medical College Hospital (MMCH), Pakistan and Sabatal Alaya Hospital, Saudi Arabia. Data (demographic information, parity and outcome variables i.e., cesarean section or vaginal delivery, elective cesarean section or emergency cesarean section) from the clinical records were retrieved. Importantly, the indicators for cesarean section mentioned in the clinical notes were also recorded. The present study also included the collection primary data on reasons for supporting women choice for caesarian section from obstetricians of Pakistan and Saudi Arabia. The data was analysed using SPSS version 21 and qualitative variables were compared between women delivered at