Caesarean section: huge differences in the world

This is one of the characteristics of the human species: having a child naturally can be especially dangerous, and therefore childbirth eventually became medicine. Thus, caesarean section was “conceived” as an alternative to overcome the most serious obstetric complications that affect the life of mother and child. However, it is a surgical procedure, necessarily riskier and much more expensive than natural childbirth.

As is often the case in medicine, it all depends on the balance of risk and benefit, and therefore WHO recommends that countries have a caesarean section rate of 10 to 15%. Below 10%, needs are not fully covered, which can lead to excess maternal and perinatal mortality. In addition, abuse is on the rise.

Alexandre Dumont and Christophe Z. Guilmoto, two researchers, compiled an overview of these practices around the world in September 2020. Estimates covering 150 countries show that at least 21% of births actually occur by caesarean section, with numbers ranging from 1% to 58%.

“This is a public health disaster”

In total, twenty-eight countries have particularly low rates, most of them in Africa. In Ethiopia, the Gambia, Madagascar and Niger, the caesarean section rate is less than or equal to 2%. “This is a disaster in terms of public health,” exclaims Marianne Benoît Truong Kang, midwife and general secretary of the National Council of the Order of Midwives. “Here, the cesarean is experienced as evil, because these women know that they will not be able to have many children. »

On the other hand, the higher the level of development, the higher the frequency of births by caesarean section. Today, one hundred countries exceed the 15% mark. Some weigh a lot, such as China (35%) or Brazil (55%). “The more midwives, the fewer caesarean sections,” continues Marianne Benoist Truong Kanh. In China, this profession has almost disappeared. When there was still a one-child policy, it was not very serious: mothers were given caesarean sections and stopped there. But since we are no longer in that perspective, this intervention takes on a different dimension. »

In France, this figure is slightly higher than the recommended 19.6%, but has remained stable since 2010.