Academic journal article Journal of Health Population and Nutrition

An Examination of Women Experiencing Obstetric Complications Requiring Emergency Care: Perceptions and Sociocultural Consequences of Caesarean Sections in Bangladesh

Academic journal article Journal of Health Population and Nutrition

An Examination of Women Experiencing Obstetric Complications Requiring Emergency Care: Perceptions and Sociocultural Consequences of Caesarean Sections in Bangladesh

Article excerpt

INTRODUCTION

Maternal mortality has been described as a problem that affects people living in poverty. Recent studies have illuminated higher risk for maternal death among socially- and economically-vulnerable people who have limited access to lifesaving obstetric hospital-care, including obstetric surgery (1-4). In Bangladesh which is a resource-poor country, nationwide data showed that maternal mortality has declined substantially over the past nine years, with the ratio decreasing from 322 in 2001 to 194 in 2010 (5). Some of the decline can be attributed to the increase in the number of deliveries at facilities, which more than doubled from 9% of births in 2001 to 23% in 2010. The use of caesarean sections also revealed a five-fold increase from 2.6% in 2001 to 12.2% in 2010 (5). Data from the Bangladesh Demographic and Health Surveys collected in 2000 and 2007 and more recent nationwide data showed that much of the increase in the number of births at facilities has been driven by the use of private-sector services (5-7). Hence, it is not surprising to see persisting socioeconomic inequities in facility-based deliveries (5,8).

Caesarean section is a surgical intervention designed to prevent or treat some life-threatening maternal or foetal complications. While the World Health Organization (WHO) recommends that the rates of caesarean births should range from 5% to 15% (9), there is little consensus regarding optimal rates of caesarean births (10). In middle- and high-income countries, much attention has been given to the increased use of elective caesarean sections carried out for the convenience of pregnant women. In resource-poor countries, except those in sub-Saharan Africa, there is also evidence of sharp increases in rates of caesarean sections as childbirth is increasingly occurring in health facilities with skilled attendants, particularly in urban settings and among wealthier people (3). In these settings, data relating to medical indications for caesarean section are lacking, thereby increasing the challenge of determining the percentage of cases that warranted caesarean surgery. However, in the 1990s, the lack of decline in maternal mortality ratios that coincided with a sharp increase in caesarean sections in resource-poor settings suggests that women delivering by caesarean section were not those in the greatest need (10). Given the high costs involved, socioeconomic disparities in access to caesarean-section procedures persist (3), and there continues to be concern that poor women who need a caesarean section may not get it, and other women who can afford to pay for a caesarean section but do not experience life-threatening complications get a caesarean section unnecessarily.

Social scientists have examined costs involved in emergency obstetric care (EmOC) and the subsequent economic burden on women and their families (11-13). However, little is known about beliefs regarding caesarean sections in cultural frameworks where deliveries at home are preferred and how the economic burden resulting from a caesarean section impacts on broader cultural and social consequences to women and their families, particularly those living in poor households located in low-income, rural settings. With the recent increase in the number of caesarean births in Bangladesh, research is needed to examine the understanding of and demand for caesarean sections and the social and psychological consequences on women undergoing a caesarean section.

To address this gap in knowledge, qualitative research was carried out among women who experienced severe obstetric complications to understand the perceptions of caesarean section and how having obstetric surgery affects women and their families. The study examined women who did and did not have a caesarean section for their birthing preparation, delivery-related experiences, and subsequent physical, social and economic consequences for the woman and her family members up to 10 weeks after delivery. …

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