Caesarean rates concerning: Motsoaledi


The increase in the rate of caesareans in public healthcare facilities is concerning, Health Minister Aaron Motsoaledi said.

"It is not a very good development that the natural method of giving birth is now being forgotten and is slowly but surely being replaced by something else," he said at the launch of Health Systems Trust's 2012/13 District Health Barometer (DHB).

The DHB provides an overview of the country's public health services in all 52 health districts in the country. It found that the national caesarean rate had increased from 12.7% in 2001/02 to 20.8% in 2012/13.

Rate highest in private sector

Motsoaledi said his disappointment arose from the fact that the rate of caesareans in the private healthcare sector was approaching 70%.

"I simply believe the indicators have nothing to do with health, but they have got everything to do with commerce."

He said it was possible that healthcare workers did not want to sit with a woman in labour, and would rather have them deliver as quickly as possible via caesarean.

The DHB found that the total number of South African adults who remained on antiretroviral therapy (ART) had increased by about 33%.

The total number of children under the age of 15 who remained on ART at the end of 2012/13 was 148 342.

The rate for antenatal (pregnant) clients initiated on ART in 2012/13 was 81.6 percent, and only 19 districts had reached the target of 85% set by the department of health.

"It is critical for women and their unborn children that pregnant HIV positive women are initiated on ARVs [antiretrovirals] as early as possible," Motsoaledi said.

Condom distribution also increased

The DHB found that the total number of condoms distributed through health facilities in South Africa had increased by 40 percent.

"Before the end of this year... I will be launching a new contraception and fertility policy. I believe... we must increase the use of modern contraceptives in our country," Motsoaledi said.

"We would like to launch this new policy under the new concept of dual protection.

"To me, it is going to be something very worthwhile... because I don't think we should keep on moaning about teenage pregnancy without waking up and doing something about it."

The DHB found that the early mother-to-child transmission of HIV was 2.4% and below the national target of three percent.

It also found that deliveries by those under the age of 18 was declining, having dropped from 9.2% in 2007/08 to 7.7% in 2012/13.

"I would like to see the accelerated reduction of teenage pregnancies. You are aware that maternal mortality among young women is significantly higher than their older counterparts," Motsoaledi said.

"There is no way of trying to stop it [younger women dying] inside the hospital during deliveries. It has to be stopped right where it is happening and that is among these very young girls."

The DHB found that the stillbirth rate, at 21.8 per 1000 births, was the lowest since 2001/02.

The cervical cancer screening rate of 55.4% in 2012/13 had exceeded the department of health's target of 54%.

It also found that the incidence and fatality rates for diarrhoea with dehydration, pneumonia and severe acute malnutrition in children under the age of five had shown a downward trend.

One of the key financial figures in the DHB is the provincial and local government expenditure on district health services per capita, which refers to the total amount spent on district health services per person without a medical scheme.

This increased in real terms from R659 in 2004/05 to R1327 in 2012/13.

The provincial primary healthcare expenditure per capita, which refers to the amount spent on non-hospital primary health care services per person without medical scheme coverage, increased from R342 in 2004/05 to R780 in 2012/13.

(Picture: caesarean section from Shutterstock)

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