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[NAIROBI] There is an urgent need for health policymakers to increase early and safe access to caesarean section in Africa to cut death of mothers and their newborns following the surgical procedure, according to a scientist.

The WHO says that countries in southern Asia and Sub-Saharan Africa account for 85 per cent of all maternal deaths and 73 per cent of all neonatal deaths resulting from birth globally.

Bruce M. Biccard, an anaesthesiologist and a professor at the University of Cape Town, South Africa, who led a multi-centre study that found the number of women and newborn children dying following caesarean section (C-section) in Africa as higher compared with  high-income countries, says that policymakers need to act fast and make it safe as Africa is still below the minimum level of the medical procedure.

“At the moment, this study shows that we are losing mothers from families, children from families.”

Bruce M. Biccard, University of Cape Town, South Africa

A caesarean section is a surgical procedure which involves cutting the wall of a mother’s abdomen to deliver a child.  

“Mothers and children are an important part of the integrity and future of any society,” he tells SciDev.Net. “At the moment, this study shows that we are losing mothers from families, children from families and the children who do survive have increased risk of epilepsy.”

The study which was conducted in 2016 across 22 countries in Africa and published in the April issue of the Lancet Global Health journal found that African mothers are at least 50 times more likely to die after caesarean delivery compared with mothers in high-income countries. It was a prospective observational study of all C-sections over a week of surgery in Africa. Follow up was until hospital discharge.

The 22 countries included Algeria, Benin, Burundi, Cameroon, Ghana, Kenya, Madagascar, Namibia, Nigeria, South Africa and Zambia.

The study which aimed to determine the state of outcomes for mothers and babies in Africa following caesarean section because of lack of data on the subject found that after the medical procedure, the death of mothers in Africa was 50 times higher than that of high-income countries while deaths from newborn children in Africa was double high-income countries and neonates had two to 11 times increased risk of epilepsy.

According to Biccard, many die from caesarean delivery in Africa because of factors such as lack of access to surgery and limited human resources to manage the procedure.

But the rate of C-sections is lower than what is expected to provide safe obstetric care in Africa, he explains. Solutions for addressing the problems include creation of awareness, increasing early access to childbirth care and training of specialists to handle childbirth and C-sections. Marleen Temmerman, a gynaecologist, professor and head of the Centre of Excellence in Women and Child Health at Aga Khan University, Kenya, says that the quality of pregnancy -and delivery care needs to be addressed.

“The problem is that women and babies who need a C-section and have no access will die because of the complications. On the other hand also in Africa, too many C-sections are performed where it is not needed which can lead to complications … in the next pregnancies,” Temmerman says.

“Caesarean section should be available when needed for all women with risks by well- trained staff in well-equipped facilities,” she says.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.


Bruce M Biccard and others  Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study (Lancet Global Health, April 2019)