For centuries, children around the world have often been born at home. As medical science advances, millions of women and their children’s lives are saved each year, but so does unnecessary use. Both India and Pakistan have seen a steady increase in the number of babies born by caesarean section, especially in private hospitals. In Pakistan, her 1 in 5 babies are born by caesarean section. The latest Pakistan Demographic and Health Survey (PDHS) report shows that the caesarean section rate has increased rapidly from 14% in her 2012-13 to 22% in 2017-18.
Is Pakistan’s caesarean section rate too high? The answer is overwhelmingly yes. The World Health Organization recommends in a statement that a caesarean section rate above 10% of hers is not associated with reduced maternal or neonatal mortality (who, 2015). Current rates exceed World Health Organization recommendations, suggesting Pakistan is part of a global trend towards non-medical Caesarean deliveries. Pakistan’s health care system is mostly private, with about 64% of the country’s health care costs being funded by the private sector (Statistical Authority of Pakistan, 2018). In our survey sample, 53% of women gave birth in healthcare facilities (Figure 1), and the caesarean section rate in private healthcare facilities was nearly 28% (Figure 2).
In the private realm of maternal health, where gynecologists, obstetricians, and staff are responsible for the individual care of pregnant women, they tend to have sole authority to make medical decisions based on the patient’s condition. In most cases, private maternal and child health organizations perform caesarean sections for profit. In public hospitals, doctors have no financial incentive to perform caesarean sections. However, the doctor’s fee and post-operative in hospital costs for performing a caesarean section with private medical facilities in Pakistan، are prohibitively expensive (depending on the type and location of the hospital). The results of this study therefore point to the need for a systematic review of private antenatal care units۔
