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Caesarean births in Turkey at 3 times WHO limit
The Health Ministry's General Directorate of Mother-Child Health and Family Planning's (AÇSAP) data show that births by Caesarean section amounted to 14 percent of all births in Turkey in 1998. The most recent data show a 31 percent increase to 45 percent in 2010. The percentage of Caesarean births in Turkey was at 20 percent in 2003, climbing to 35 percent in 2007, 37 percent in 2008 and reaching 43 percent in 2009. While C-sections make up at least 25 percent of births in the provinces of Ağrı, Ardahan, Kars and Bayburt, it is the cities in the western Marmara and Black Sea regions that lead the country, with 55 percent of babies delivered by Caesarean sections.
According to the WHO, the allowable limit of C-sections for medical reasons varies between 15 and 18 percent. There is no apparent justification for Turkey's 45 percent rate. The Ministry of Health launched a media campaign earlier this year to help curb increasing rates of birth by C-section and set a target to reduce the rate to 35 percent by the year 2013. However, there are persistent concerns about the extent to which the ministry's action plan can penetrate the surface of this complex issue.
Even before the ministry's campaign began, Health Minister Recep Akdağ urged women to exercise due caution with C-sections: “When presented with the option of having a Caesarean, mothers-to-be should question the reasoning behind this.” Drawing attention to the excessive rate of C-sections in Turkey, Health Minister Recep Akdağ called on mothers to avoid Caesarean sections unless they are necessary.
The Health Ministry conducted several studies to determine how best to reduce the high rate of Caesareans. The ministry worked with hospitals on devising feasible solutions, such as enhancing the training of doctors and better informing the public about their birth options and the potential dangers of C-sections. In addition, the Social Security Institution (SGK) reduced state support for Caesarean sections from TL 675 to TL 475 and increased state support for normal births from TL 250 to TL 400. For the time being, however, the high rate of C-sections persists.
Experts have come forward to voice concern over what they call the over-simplification of a complex issue. İstanbul obstetrician and gynecologist Dr. Yıldız Tanrısever warned that there is more than meets the eye when looking at Turkey's Caesarean statistics. She said while the current statistics show a 45 percent rate overall, the rate of C-section births can be as high as 90 percent in some hospitals.
A 2010 study by Professor Sabahat Tezcan, the director of Hacettepe University's Institute of Population Studies and the Public Health Foundation, on Turkey's dangerously high pattern of Caesarean deliveries said that because a C-section is a serious surgical procedure, it can carry great potential risks and may be dangerous to the health of the mother or the baby.
Caesareans do reduce the risk from problems like cord entanglement in childbirth and can of course be necessary in the case of such complications as breech presentation. However, it is a major surgery and as such brings with it abdominal inflammation, stitches and a higher risk of internal bleeding. Also, women who undergo Caesareans generally experience more blood loss than those who deliver normally. Pain around the area of the stitches typically continues for three to four days after a C-section, which can make it more difficult for the mother to breastfeed. According to Tezcan, a Caesarean should only be performed when the health of the mother or baby would otherwise be put at risk.
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