|10. Over-medicalisation of Maternal Care in Developing Countries|
We have found high frequencies of obstetrical interventions in every region of the developing world. There is an ongoing epidemic of caesarean sections in Asia and Latin America. There is no indication of rising rates of caesarean sections in Africa, but rates are already high in many countries of East and Southern Africa.
The low rates of caesarean sections observed in many West African countries might reflect a lack of resources more than a consensus of birth attendants. Episiotomies and oxytocics are used very often in African countries having low caesarean section rates. This suggests that many birth attendants favor frequent use of interventions. Better availability of operating theaters in such countries could thus trigger the same epidemic of caesarean sections as the one observed elsewhere. Better availability of operating theaters is of course urgently needed, but should, in our opinion, be accompanied by the promotion of evidence-based practices. This should not be limited to appropriate use of caesarean sections, episiotomies, and oxytocics. Many other interventions might be overused, even though data are not available to study trends in their use. There is a need for in depth studies on the use of interventions such as perineal shaving, enema, and vacuum and forceps extraction.
We conclude that there is indeed a world-wide epidemic of obstetrical interventions, and that countries that have not observed such epidemic yet will probably face it soon. This should by no mean slow down our efforts to provide better access to obstetrical care. However, it should encourage us to build stronger strategies to promote evidence-based interventions.