Rising Rate of Ceserean Section in Nepal

Download Article

DOI: 10.21522/TIJPH.2013.SE.19.01.Art007

Authors : Arju Chand Singh


Caesarean section is one of the most common and lifesaving surgeries performed in modern obstetrics. In a developing country like Nepal where health care resources are limited, this rising trend definitely has major implication but it is essential to perform when complications arise during pregnancy and labour without this large number of women and their unborn babies die every year, especially in low-income countries. The World Health Organization suggests 10-15% cesarean section rate and has suggested to be done only when justified by a medical condition2. It states that, at a population level, if cesarean section rates higher than 10% does not reduce the maternal and neonatal mortality rates, and it should be performed only when medically justified. Otherwise unnecessary health of mother and babies including social and economic implications would challenge childbearing women, babies, their families and the state. Recently in Nepal there is a sharp rising trend of cesarean section rates from 20 to 81% in different hospitals especially in the private setting indicating over-medicalization of childbirth unnecessarily performing without medically justified. This arise the issue of human rights violence of childbearing women and professional integrity of a practitioner and safety of the clients. The World Health Organization recommended use of the Robson criteria which would be one of the best strategies in reducing the frequency of the procedure that should include avoidance of medically unnecessary primary cesarean section and improving case selection for induction and prelabour cesarean section besides educating childbearing women and their families about the consequences of unnecessary request of the procedure.

Keywords: Cesarean section; Rate; World health organization, Violence.


[1].     Amatya A, Paudel R, Poudyal A, Wagle RR, Singh M, et al. (2013) Examining stratified cesarean section rates using Robson classification system at Tribhuvan University Teaching Hospital. J Nepal Health Res Counc 11(25): 255-258.

[2].     Caesarean sections. Postnote No. 184. London: Parliamentary Office of Science and Technology; 2002. Available from: http://www.parliament.uk /post/pn184.pdf.

[3].     C Black, JA Kaye, H Jick. Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, et al. (2016) The increasing trend in cesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS ONE 11(2): e0148343.

[4].     Data and sourcesS1 File. First and latest available CS rate data points per country, the year, total number of data points used for this analysis and sources of the data.

[5].     Lamichhane B, Singh A (2014) Changing trend in instrumental vaginal deliveries at Patan Hospital. Nepal J Obstet Gynaecol 20(2): 22-35.

[6].     Lokugamage AU, Pathberiya SDC (2017) Human rights in childbirth, narratives and restorative justice: a review. Rep Health 14: 17.

[7].     Montagu D, Yamey G, Visconti A, Harding A, Yoong J. Where do poor women in developing countries give birth? A multi-country analysis of demographic and health survey data. PLoS One 2011; 6: e17155.

[8].     Ministry of Health (2017) Nepal demographic and health survey 2016. Ministry of Health, Nepal.

[9].     Ministry of Health (2012) Nepal demographic and health survey 2011. Ministry of Health, Nepal.

[10]. Perez DR (2010) Obstetric violence: a new legal term introduced in Venezuela. Int J Gynecol Obstet 111(3): 201-202.

[11]. Parkhurst JO, Rahman SA. Lifesaving or money wasting? Perceptions of caesarean sections among users of services in rural Bangladesh. Health Policy2007; 80: 392-401.

[12]. Pope TM (2017) Legal Briefing: unwanted cesareans and obstetric violence. J Clin Ethics 28(2): 163-173. 33.

[13]. Robson MS (2001) Can we reduce the cesarean section rate? Best Pract Res ClinObstet Gynecol 15(1): 179-194.

[14]. Schantz C, Sim KL, Petit V, Rany H, Goyet S (2016) Factors associated with cesarean sections in Phnom Penh, Cambodia. Rep Health Matters 24(48): 111-121-44.

[15]. The American College of Obstetrics and Gynecology Committee on Obstetric Practice, The Society for Maternal-Fetal Medicine. (2013) Committee Opinion Number 561: Nonmedically Indicated Early-Term Deliveries. Obstet Gynecol 121: 911-915.

[16]. Vogel JP, Betran AP, Vindevoghel N, Souza JP, Torloni MR, et al. (2015) Use of the Robson classification to assess cesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. The Lancet Global Health 3(5): e260-e270.

[17]. World Health Organization. Appropriate technology for birth. Lancet 1985; 2(8452):436-7.

[18]. WHO World Health Organisation (2015) WHO Statement on cesarean section rates.