The number of births by caesarean section has almost doubled in the world in fifteen years, from 12% to 21% between 2000 and 2015, exceeding even 40% in 15 countries, leading gynecologists to question this "epidemic", in a file published in the Lancet Friday.
It is estimated that 10-15% of cesareans are absolutely necessary for medical reasons. But 60 percent of the 169 countries surveyed are above this range while a quarter of the countries are below, endangering both mother and child, says study based on WHO figures and of Unicef.
In 15 countries, more than 40% of births take place by caesarean section (Dominican Republic, Brazil, Egypt, Turkey, Venezuela, Chile, Colombia, Iran etc.).
"The strong increase in caesarean sections – mostly in easy and unhealthy environments – is problematic because of the associated risks for the mother and child," says study coordinator Marleen Temmermann (Aga Khan University of Kenya and Ghent University in Belgium).
"In cases where complications occur, cesareans save lives and we need to promote women's access (to this operation) in poor areas, but we should not abuse it."
The disparities are overwhelming between sub-Saharan Africa (4.1% of cesarean section) and Latin America and the Caribbean, where the rate reached 44.3% in 2015.
In Asia, the use of caesareans increased on average by 6% per year, climbing from 7.2% to 18.1% of births between 2000 and 2015. In North America (32% of Caesareans in 2015) and in Europe Western (26.9%), the increase is about 2% per year.
The Lancet study, based on data collected by WHO and UNICEF, does not explain this dramatic increase in caesarean sections in some countries.
However, it notes a link with the level of income and education of women: for example, in Brazil, caesareans account for 54.4% of births for women with a high level of education compared to 19.4% for women with less education. .
– France stable around 20% –
In low- and middle-income countries, wealthier women are six times more likely to deliver by caesarean section than the poor, and operations are 1.6 times more likely in private clinics.
The World Congress of Gynecology and Obstetrics gathered in Brazil advances several avenues in the Lancet on the reasons for this "epidemic": a decline in the competence of the medical profession to accompany a potentially difficult childbirth by natural route, the comfort of the programming of day births, more attractive rates for doctors and clinics in case of cesarean section …
In France, the rate of caesarean section (20.4% in 2016) remains stable since 2010, "which suggests a general attitude tending to limit the achievement of this intervention," notes the latest perinatal survey published by the Ministry of Health.
Cédric Grouchka, a member of the College of the French High Health Authority speaks of "downward stabilization" and makes a distinction between "caesareans performed in a hurry, either after a delivery that goes wrong or during work, which 60% of the total in France, caesareans scheduled for medical reasons (40%) and those scheduled for a non-medical reason, at the request of women ", he estimates" less than 1% ".
For Jane Sandall of King's College London, if some women choose a caesarean, it is usually "fear of childbirth, sometimes after a traumatic first experience". The quality of care and facilities, which must preserve the privacy of women and allow the presence of a loved one, are essential in the face of these fears, she believes.
The World Congress of Gynecology (FIGO) advocates several ways to limit the abuse of caesareans: to apply a single rate for births, cesarean section or not, require hospitals to publish their statistics, better inform women of risks, improve training to natural childbirth.