Sexual and reproductive health

Caesarean sections should only be performed when medically necessary says WHO

WHO publishes statement on the rates of caesarean section, and proposes use of Robson classification system

Uganda: a young woman suffers from pain during labour.
UNICEF/Noorani

WHO’s statement illustrates how important it is to ensure caesarean section are provided to the women in need – and not just focus on achieving any specific rate.

Dr Marleen Temmerman, Director of WHO Department of Reproductive Health and Research including HRP

Since 1985, the international healthcare community has considered the ideal rate for caesarean sections to be between 10-15%. Since then, caesarean sections have become increasingly common in both developed and developing countries. The WHO statement published today says that when caesarean section rates rise towards 10% across a population, the number of maternal and newborn deaths decreases. When the rate goes above 10% there is no evidence that mortality rates improve. Across a population, the effects of caesarean section rates on maternal and newborn outcomes such as stillbirths or morbidities like birth asphyxia are still unknown and more research on the impact of caesarean section on women’s psychological and social well-being is needed.

Dr Marleen Temmerman, Director of WHO Department of Reproductive Health and Research including HRP states, “These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns. They also illustrate how important it is to ensure caesarean sections are provided to the women in need - and to not just focus on achieving any specific rate.”

When medically necessary

WHO says medical practitioners should not undertake caesarean sections purely to meet a given target or rate, but rather focus on the needs of patients.

Caesarean sections can cause significant complications, disability or death, particularly in settings which lack the facilities to conduct safe surgeries or treat potential complications. Due to their increased cost, high rates of unnecessary caesarean sections can pull resources away from other services in overloaded and weak health systems.

The Robson classification

Improved understanding of caesarean section rates has been hindered by the lack of a consistent, internationally-accepted classification system to monitor and compare caesarean section rates. To address this lack, WHO proposes the adoption of the Robson classification system, which can facilitate comparison and analysis of caesarean rates within and between different facilities, and across countries and regions.

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