The Ghana Health Service (GHS) has described as quite high the number of women opting for caesarean sections (CS) in the country as against the spontaneous vaginal delivery (SVD). It said from the 2022 Demographic and Health Survey (GDHS) report released last week, one in every five women who delivered in the country did so through CS, a figure which it explained was quite high compared to World Health Organisation (WHO) recommendation for the country.
It said generally at the country’s population level, a 15 per cent CS rate was acceptable but that was not the case presently as the country, per the 2022 GDHS report, had a nationwide caesarean section rate of 21 per cent. The high rate of CS had implications for the country, the Deputy Director, Reproductive and Child Health of the GHS, Dr Chris Opoku Fofie, stated in Accra yesterday at the dissemination of the 2022 GDHS report on maternal, child health and malaria.
“The more we have women delivering through caesarean section, the more burden is put on the health system and so those that might need the intervention to survive would not get it in a timely manner”. “We want to have caesarean sections, but there should be a way to ensure that those who need caesarean sections most are those getting it but not as a remedy for all other women who come around. If you don’t need it and you get it, you deprive others from getting the life-saving intervention,” he explained.
A caesarean section is a surgery to deliver a baby through one’s abdomen and uterus. It is performed when a vaginal delivery is not safe or possible. Dr Fofie explained that pregnant women that might require CS delivery included those whose babies were having problems coming out or the baby’s size was too big.
The Demographic and Health Survey report is a population-based survey designed to monitor progress on health service utilisation and management to inform decision-making.
Since 1998, the survey has been conducted, led by the Ghana Statistical Service (GSS), in collaboration with the Ministry of Health, the GHS and other stakeholders.
The information is intended to be used by programme managers and policymakers to evaluate and improve existing programmes. The fieldwork for the latest survey was conducted between October 17, 2022 and January 14, 2023.
A nationally representative sample of 15,014 girls and women aged between 15 and 49 years in 17,933 households, and 7,044 boys and men aged 15 to 59 years in half of the selected households were interviewed in the latest survey.
Dr Fofie explained that up to a certain level, caesarean sections would help to reduce complications and death but when it went beyond that level to a point where everyone was opting for it, that would not necessarily improve care.
He said the survey further looked at where the CS was performed most and from the report, it established that 27 per cent of urban dwellers opted for CS as against 15 per cent by rural dwellers.
For instance, the Reproductive and Child Health Deputy Director said from their facility data, the Greater Accra Region had a CS rate of 29 per cent of all deliveries as of last year, but when narrowed to specific hospitals, some of them were performing up to 45 per cent rate which, according to him, was alarming.
“We are not saying caesarean section is bad, all we are saying is that we should be able to have a system where we will distinguish between those who really need it from those who are requesting it, so that when you need your caesarean section to survive, you get it in a timely manner,” he said.
Touching on delivery, Dr Fofie said the report indicated that most deliveries were performed by the nurses and midwives group, representing 70 per cent, while for deliveries done by doctors, it was 19 per cent and unskilled delivery, that is those performed by traditional birth attendants, represented seven per cent.
Education, wealth quintile
The report also established a relationship between the level of education of mothers and the type of delivery they opted for or the venue of delivery. Dr Fofie explained that while 74 per cent of women with no education had skilled delivery, the figure increased to 84 per cent for those who had primary education and for those with secondary education, 92 per cent of them had skilled delivery while those who had above secondary education were 99 per cent.
“This means that if we invest in education, definitely we will get many more people delivering within our facilities. So we have to focus on education,” he said. For wealth, he said, of those that were in the lowest wealth quintile (the poorest), 73 per cent had skilled delivery as against 98 per cent for those in the highest wealth quintile (the wealthiest).
A monitoring and evaluation specialist of the GHS, Solomon Boamah, stated that the findings of the report resonated well with GHS and the service appreciated the efforts put in by the GSS to produce the report. A demographer at the Regional Institute for Population Studies (RIPS), University of Ghana, Professor Stephen O. Kwankye, said the report showed that the country was doing well even though there were gaps which needed to be tackled.
By: Augustina Tawiah