Moalims

 Caesarean section (C-section) is a major surgical procedure that surely has medical justification behind its induction. Overall the C section deliveries are 16 per cent in Pakistan which shows a slightly above prevalence to recommended 15pc rate, according to a research report of Pakistan Institute of Development Economics (PIDE).
However, this figure for urban areas of Pakistan did not turn out to be encouraging ie about 26pc C-section deliveries. It was easily predictable that the rate of C-section would be high in urban areas than rural ones, as there medical facilities concerning maternal care were available to target population, and hence the findings were just as expected.
In the provinces of Punjab and Sindh, C-section rates in urban areas are found at higher end around 27pc as compared to rural areas where these have been found 15 and 10pc, respectively. Khyber Pakhtunkhwa and Balochistan showed much low rates than Punjab and Sindh, especially in Balochistan where it seemed that institutional maternal care was extremely at lower limit. The rate of C-section deliveries in rural areas of Balochistan and KP were drastically low, 1.433 and 3.63pc, respectively.
This also probably indicated both the unavailability of medical infrastructure and at the same time low utilization of maternal care by the population. Low rate of C-section also has been found in rural Gilgit-Baltistan. One of the most interesting figures came out for Islamabad, where C-section deliveries were as high as 33pc for urban and 23pc for rural region. These sky high rates in capital city of the country could be due to easy access to medical infrastructure both in public and private and the socio-economic profile of the population.
In many studies it has been found that women with better socio-economic background would have higher rates for C-section deliveries. It has also been found that there was a marked difference of 30 percentage point among poorest and richest income quintiles in C-section rates. There was an increasing trend of C-section deliveries from poorest to richest quintiles. The richer and richest quintiles women have 23 and 35pc C-section deliveries as compared to women from the other three quintiles where this rate was lower than 12pc.
The same trend has been found in case of educational profile of women. Higher C- section rates for the highly educated women than women with low education have been found. In fact, low preference/utilization of C-section has been found for women with no education category, where this rate was 7.5pc. At the same time, women with matric, secondary and higher education showed alarming percentages of C-section with 21, 31 and 43pc, respectively. Women belonging to better socio-economic background are presumed to be availing private facilities more due to the affordability factor, which open up possibility of higher C-section rates in these facilities.
Moreover, it has also been found that women living in urban areas, having high income background, and from higher education profile have higher levels of C-section rates. It is possible that private facilities might have higher rates of C-section than public ones because of the nexus of income, education and area of residence that somehow explained the decision-making power of women to go for C- section without having any medical complication. On the other hand, that also explained exploitation of this population group by the private maternal care facilities to make money out of unnecessary intervention of C-section.
However, no remarkable difference in C-section rates between public and private facilities both in urban and rural areas have been found. In urban areas C-section rates in both facilities are almost same about 35pc in pubic and 36pc in private hospitals. In rural areas this difference was only about four percentage point. The high rates of C-section rates in public hospitals are often justified by the high number of referrals in these hospitals from the periphery medical facilities.

News Reference: http://www.brecorder.com/general-news/172/1204340/