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Duke University

Publication Date

Fall 12-1-2014

Program Name

Argentina: Public Health in Urban Environments

Abstract

Introduction: The ways in which women of society give birth have the power to influence maternal-infant health and shape the economy of the healthcare system. Today, the rates of cesarean sections are increasing throughout the world. In Argentina, on average, more than 35% of pregnant women received cesarean sections in 2008, with large differences observed in the rates between the public and private health sectors. The World Health Organization (WHO) has established that healthcare systems should only employ a cesarean section if labor cannot progress safely. According to this standard, the organization estimates that cesarean sections should only be utilized in 10 – 15% of pregnancies. WHO therefore considers cesarean sections beyond this percentage as unnecessary surgeries. Definition of the problem: Various investigations have shown positive associations between the increasing rates of cesarean section and maternal-fetal morbidity and mortality in addition to economic burdens for the healthcare system. Initially, experts believed that women’s demand for cesarean sections was the major factor causing the increase in cesarean rates. However, many studies have shown that approximately only 15% of women around the world would prefer a cesarean section in place of natural birth. Therefore, there is a discrepancy between the growing rates of cesarean section and patient preferences. Objective: This investigation aims to explore the opinions of reproductive health professionals employed in both the public and private health sectors concerning the practices of natural and cesarean birth in the Province of Buenos Aires. Methodology: Sixteen female professionals completed the provided survey (Apéndice). The group consisted of nine obstetrician/gynecologists and seven licensed obstetricians. Half of the participants work more than 80% of the time in the public health sector, and the other half work less than 80% of the time in the public health sector. Ten of the professionals have more than ten years of experience in their medical careers, and six had less than or equal to ten years of experience. They answered open and closed questions according to the ethical guidelines of informed consent. Opinions were analyzed collectively and according to profession, sector of employment, and years of experience. Conclusions: Data establishes that the majority of surveyed professionals consider the growing rates of cesarean sections a public health problem. Beyond the preferences of the patients, reproductive health professionals in greater Buenos Aires believe that socio-demographic factors, such as age, educational level, socioeconomic status and number of children, can influence the means by which a woman gives birth. Beyond patients, participants highlighted the benefits that professionals can receive in the practice of a cesarean section. In the private sector, doctors can schedule appointments in order to save time and organize working life; in the public sector, doctors can evade legal consequences such as malpractice lawsuits. Responses further illuminated that lack of anesthesiologists, a human resource, is an obstacle in the practice of cesarean sections. From all of this information, it is evident that the cause of cesarean rates in Argentina is multifactorial. However, there is no doubt that opinions, benefits, and obstacles of professionals that administer cesarean sections, in addition to the preferences of the patients, are influencing the current rates of cesarean sections.

Disciplines

Community Health | Emergency Medicine | Health and Medical Administration | Health Economics | Health Services Research | International and Area Studies | Latin American Studies | Maternal, Child Health and Neonatal Nursing | Medical Education | Obstetrics and Gynecology | Perioperative, Operating Room and Surgical Nursing | Public Health | Reproductive and Urinary Physiology | Surgery

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