Birth by Caesarean section in developing countries - Life-saving interventions or financial exploitation?

Caesarean section rates have risen dramatically in several developing countries, especially in Latin America and South Asia. This raises a range of concerns about the use of c-section for non-emergency cases, not least the progressive shift of resources to non-essential medical interventions in resource-poor settings. There are also rising concerns about the additional health risks to mothers and newborns following c-section. Little systematic analysis exists on how different countries compare in terms of the factors that really influence climbing -section rates. In particular it is not clear whether high elective c-section rates are driven by doctors or by women's decisions. Also more needs to be done on how network interaction with peers and relatives has an impact on women's willingness to plan for a c-section. Using multilevel logistic regression this paper analyses the institutional, socio-economic and community factors that influence c-sections in six countries: Bangladesh, Colombia, Dominican Republic, Egypt, Morocco and Vietnam. The analysis of over 20000 births shows that better educated and wealthier women have higher odds of a Caesarean birth with a clear sign that women of higher socio-economic background might opt for elective c-sections. Access to antenatal or health services didn't show significant results. Moreover women's exchange of information with friends and family on reproductive health matters can also lower their odds of having a Caesarean section. This paper is set into a wider context of public health intervention. It investigates the need to look into community based approaches for curbing rising c-section rates in resource-poor settings.