Recommendations for Routine Reporting on Indications for Cesarean Delivery in Developing Countries

Authors

  • Cynthia Stanton MPH, PhD,

    Corresponding author
    1. 1Cynthia Stanton is an Assistant Professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; and 2Carine Ronsmans is a Reader in the Infectious Disease Epidemiology Unit at the London School of Hygiene and Tropical Medicine, London, United Kingdom.
      Cynthia Stanton, MPH, PhD, 118 Larch Road, Cambridge, MA 02138, USA.
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  • 1 Carine Ronsmans MD, DrPH,

    1. 1Cynthia Stanton is an Assistant Professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; and 2Carine Ronsmans is a Reader in the Infectious Disease Epidemiology Unit at the London School of Hygiene and Tropical Medicine, London, United Kingdom.
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  • and 2 the Baltimore Group on Cesarean

    1. 1Cynthia Stanton is an Assistant Professor in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; and 2Carine Ronsmans is a Reader in the Infectious Disease Epidemiology Unit at the London School of Hygiene and Tropical Medicine, London, United Kingdom.
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  • This work was funded by an international research program, the Initiative for Maternal Mortality Programme Assessment (IMMPACT, http://www.abdn.ac.uk/immpact) at the University of Aberdeen, Aberdeen, Scotland. The program is funded by the Bill & Melinda Gates Foundation, Seattle, Washington, USA; the Department for International Development, London, United Kingdom; the European Commission, Brussels, Belgium; and United States Agency for International Development, Washington, DC, USA. The funders have no responsibility for the information provided or views expressed in this paper.

  • *

    Members of the Baltimore Group on Cesarean are listed in Appendix 1.

Cynthia Stanton, MPH, PhD, 118 Larch Road, Cambridge, MA 02138, USA.

Abstract

ABSTRACT: Background: Cesarean delivery rates are increasing rapidly in many developing countries, particularly among wealthy women. Poor women have lower rates, often so low that they do not reach the minimum rate of 1 percent. Little data are available on clinical indications for cesarean section, information that could assist in understanding why cesarean delivery rates have changed. This paper presents recommendations for routine reporting on indications for cesarean delivery in developing countries. These recommendations resulted from an international consultation of researchers held in February 2006 to promote the collection of comparable data to understand change in, or composition of, the cesarean delivery rate in developing countries. Methods: Data are presented from selected countries, categorizing cesareans by three classification systems. Results: A single classification system was recommended for use in both high and low cesarean delivery rate settings, given that underuse and overuse of cesarean section are evident within many populations. The group recommended a hierarchical categorization, prioritizing cesareans performed for absolute maternal indications. Categorization among the remaining nonabsolute indications is based on the primary indication for the procedure and include maternal and fetal indications and psychosocial indications, required for high cesarean delivery rate settings. Conclusions: Data on indications for cesarean sections are available everywhere the procedure is performed. All that is required is compilation and review at facility and at higher levels. Advocacy within ministries of health and medical professional organizations is required to advance these recommendations since researchers have inadequately communicated the health effects of both underuse and overuse of cesarean delivery. (BIRTH 35:3 September 2008)

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