Challenges affecting access to cesarean delivery and strategies to overcome them in low-income countries.

Overview

BACKGROUND: Most maternal deaths occur in low-income countries where access to appropriate medical care is restricted. OBJECTIVES: To evaluate rates of cesarean deliveries and identify barriers to this mode of delivery in low-income countries. SEARCH STRATEGY: A review of Medline and PubMed was performed to identify reports published in English or French using the keywords "cesarean section," "maternal mortality," and "developing countries." SELECTION CRITERIA: Studies investigating the obstacles to cesarean delivery and plans to overcome them in low-income countries were included. DATA COLLECTION AND ANALYSIS: Data from included studies were extracted and analyzed. MAIN RESULTS: Studies from 16 countries in Sub-Saharan Africa were included. The average rate of cesarean delivery was 3.6% (range 1.5%-7.1%). The rate was negatively correlated with the maternal mortality ratio (r=-0.63; P=0.005), neonatal mortality rate (r=-0.81; P<0.001), and infant mortality rate (r=-0.80; P<0.001). Major barriers to achieving higher rates of cesarean deliveries include poverty, limited access to healthcare services, and a shortage of skilled providers. CONCLUSIONS: Maternal and infant mortality rates could be lowered by increasing access to cesarean delivery. Additional education of patients and providers, establishment of more heath facilities, and governmental support of obstetric care could help to reach this goal.

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics Journal