The rising rate of cesarean births in Cambodia could be cause for concern if the increase is following a global trend of more c-sections performed without medical necessity, according to research published yesterday.
The study, which was published in the British medical journal The Lancet, compiled data on births in Cambodia and eight other Asian countries between 2007 and 2008 and concluded that in order to “improve maternal and perinatal outcomes, cesarean section should be done only when there is a medical indication.”
Although Cambodia had by far the lowest delivery-by-c-section rate of those studied–the Ministry of Health and World Health Organization put it at just under 2 percent, compared to 17.4 percent in Thailand and 40.5 percent in China–the findings nevertheless have major implications for a country struggling to improve maternal health, said lead author, A Metin Gulmezoglu, a scientist at the WHO’s Department of Reproductive Health and Research in Geneva.
“The implication is that even in poorer countries where there may not be very high rates, ‘medically not indicated’ cesareans are still likely to occur,” he said via e-mail yesterday.
“In those situations, not having adequate support systems such as blood banks or intensive care facilities could put mothers at higher risk than those in better-resourced countries,” he added, noting that the findings are equally applicable to a country at the low end of the c-section spectrum.
Whether Cambodia has too many or too few cesareans is a contentious issue.
Lo Veasknakiry, deputy-director of planning and health information at the Health Ministry, said yesterday that the procedure is still very much one of medical necessity.
“In Cambodia, we mostly use it for complicated delivery or due to a medical condition. Our policy on c-sections is that they’re for emergency obstetric care.”
But some cite an increasing number of women, those who can afford to do so, turning to c-sections for convenience or even good luck.
“Nowadays, most women give birth naturally because they are mostly poor,” said Muong Tito, secretary-general at the Cambodian Association of Private Clinics. “But sometimes we see rich women asking fortune tellers which is an auspicious day to give birth and then getting c-sections. Still not many, though.”
(Additional reporting by Saing Soenthrith)