Medicalization of Reproduction: Understanding the Dynamics of Increasing Trend in C-section Rates among the Women of Lahore, Pakistan

Abstract

Background: C-section (CS) can be a lifesaving practice for both the mother and the infant when medically indicated. However, unnecessary CS may lead to higher medical risks for both the mother and the baby.

Objective: This study explores the factors contributing to growing rates of the caesarean section (C-section) in Pakistan.

Methods: Qualitative research design was adopted for this study and in-depth interviews were conducted with 20 post C-section women and five gynaecologists at government tertiary care hospitals and private hospitals in Lahore.

Results:  The caesarean section (C-section) rates in Pakistan has increased from 3.2% in 1990 to 20% in 2018. Data analysis shows that six medicalization factors contributed to higher C-section rates: 1) Financial incentives and time convenience, 2) Marketing of C-section, 3) Maternal request for C-section, 4) Self-medication, 5) Lack of second opinion, and 6) Quality of care at public and private health facilities.

Conclusions: Thematic analysis showed that financial incentives of doctors, poor quality of care at public health care facilities and lack of second opinion were the significant factors for increasing trends of C-section. Whereas gynaecologists argued that the maternal request for C-section and self-medication were the major contributors of rising rates of C-Section in Pakistan. There is a dire need to create awareness among women related to the risk factors associated with unnecessary CS, while medical community also needs to be sensitized about the ethical obligations and implications related the medical practice.  This would assist in minimising the rates of CS and unnecessary elective surgeries.