Caesarean section in Benin and Mali: increased recourse to technology due to suffering and under-resourced facilities: Increased recourse to caesarean sections in Mali and Benin

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Study Justification:
– The study aims to address the increasing rates of caesarean sections in low-income countries, specifically in Mali and Benin.
– The medicalization of childbirth is on the rise, but access to healthcare services remains difficult for many women.
– The high caesarean section rates in hospitals in Mali and Benin contradict the low rates in the general population.
– The study seeks to understand the reasons behind this paradoxical situation and its implications for maternal and infant health.
Highlights:
– The study utilized a qualitative approach, including workshops, participant observation, and in-depth interviews with obstetricians, midwives, caregivers, patients, and policy makers.
– Two types of caesarean sections were identified: “maternal distress caesarean section” and “preventive caesarean section.”
– The main reasons for these caesarean sections were maternal fear and pain, as well as a lack of resources in the healthcare facilities.
– Inadequately resourced facilities led to staff suffering and ethical breakdowns, contributing to the inappropriate use of technology.
– The policy of providing free caesarean section procedures further exacerbated the issue of non-medically-justified caesarean sections in these countries.
– The overuse of caesarean sections poses a danger to both mothers and babies in the short and long term, especially in countries with high fertility rates.
– The study highlights the need to address the increasing rates of non-medically-justified caesarean sections in Benin and Mali to prevent further burden on these sub-Saharan countries with already high maternal mortality rates.
Recommendations:
– Improve access to healthcare services for women, particularly in low-income countries, to reduce the need for non-medically-justified caesarean sections.
– Enhance training and support for healthcare providers, including obstetricians and midwives, to ensure appropriate decision-making regarding caesarean sections.
– Allocate resources to healthcare facilities to address the under-resourced conditions that contribute to the overuse of technology and inappropriate caesarean section practices.
– Review and revise the policy of providing free caesarean section procedures to ensure that they are medically justified and not contributing to unnecessary surgeries.
– Implement public health campaigns to educate women about childbirth options and dispel fears and misconceptions surrounding vaginal delivery.
Key Role Players:
– Obstetricians and gynecologists
– Midwives
– Nurses and healthcare staff
– Policy makers and government officials
– Non-governmental organizations (NGOs) working in maternal and child health
– Community leaders and advocates for women’s health
Cost Items for Planning Recommendations:
– Training programs for healthcare providers
– Infrastructure improvements in healthcare facilities
– Equipment and technology upgrades
– Public health campaigns and educational materials
– Research and data collection efforts
– Monitoring and evaluation systems to assess the impact of interventions

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative approach, including workshops, participant observation, and in-depth interviews. While these methods provide valuable insights, they may not be as robust as quantitative studies. To improve the strength of the evidence, conducting quantitative studies to complement the qualitative findings would be beneficial. Additionally, including a larger sample size and diverse population would enhance the generalizability of the results.

In line with policies to combat maternal mortality, the medicalization of childbirth is increasing in low-income countries, while access to healthcare services remains difficult for many women. High caesarean section rates have been documented recently in hospitals in Mali and Benin, illustrating an a-priori paradoxical situation, compared with low caesarean section rates in the population. Through a qualitative approach, this article aims to describe the practice of caesarean section in maternity wards in Bamako and Cotonou. Workshops with obstetricians and midwives; participant observation inside labour rooms; and in-depth interviews with caregivers, patients and policy makers have indicated increased recourse to caesarean section due to women’s and caregivers’ suffering and under-resourced facilities. Within these procedures, two types of caesarean section were documented: ‘maternal distress caesarean section’ and ‘preventive caesarean section’. The main reasons for these caesarean sections are maternal fear and pain, and a lack of resources. Inadequately resourced facilities lead to staff suffering and ethical breakdowns, and encourage the inappropriate use of technology. The policy of access to free caesarean section procedures exacerbates the issue of non-medically-justified caesarean sections in these countries. The overuse of caesarean section is particularly alarming in countries with high fertility as it constitutes a danger to both mothers and babies in the short and long term. Currently, conditions are in place in Benin and Mali for an increase in non-medically-justified caesarean sections. In the short term, such an increase could constitute a new burden for these two sub-Saharan countries, where maternal mortality is high.

Based on the provided information, here are some potential innovations that could be recommended to improve access to maternal health:

1. Strengthening healthcare infrastructure: Investing in improving and expanding healthcare facilities, particularly maternity wards, in Mali and Benin can help address the issue of under-resourced facilities. This could involve upgrading existing facilities, providing necessary medical equipment and supplies, and ensuring a sufficient number of skilled healthcare professionals.

2. Training and capacity building: Implementing comprehensive training programs for healthcare providers, including obstetricians and midwives, can help improve their skills and knowledge in managing childbirth and reducing the need for unnecessary caesarean sections. This can include training on evidence-based practices, emergency obstetric care, and pain management techniques.

3. Promoting alternative birthing methods: Educating women and healthcare providers about alternative birthing methods, such as vaginal birth after caesarean (VBAC) and non-pharmacological pain management techniques, can help reduce the reliance on caesarean sections. This can be done through awareness campaigns, educational materials, and training programs.

4. Addressing maternal fear and pain: Implementing strategies to address maternal fear and pain during childbirth, such as providing emotional support, offering pain relief options, and promoting positive birthing experiences, can help reduce the demand for caesarean sections driven by these factors. This can involve training healthcare providers in providing compassionate care and creating a supportive birthing environment.

5. Strengthening healthcare policies: Reviewing and revising existing healthcare policies, particularly those related to access to free caesarean section procedures, can help ensure that caesarean sections are performed based on medical necessity rather than non-medical factors. This can involve establishing clear guidelines and criteria for caesarean section eligibility and implementing monitoring mechanisms to prevent overuse.

It is important to note that these recommendations are based on the information provided and may need to be further tailored and contextualized to the specific healthcare systems and cultural contexts of Mali and Benin.
AI Innovations Description
Based on the description provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Title: Strengthening Maternal Health Facilities and Promoting Evidence-Based Practices in Benin and Mali

Description: To address the issue of increased recourse to caesarean sections in Mali and Benin, it is crucial to focus on improving access to maternal health services and promoting evidence-based practices. Here is a recommendation that can be developed into an innovation:

1. Strengthening Healthcare Infrastructure: Invest in improving the infrastructure and resources of maternity wards in Bamako and Cotonou. This includes ensuring the availability of essential medical equipment, supplies, and skilled healthcare professionals to provide quality maternal care.

2. Training and Education: Conduct comprehensive training programs for obstetricians, midwives, and other healthcare providers on evidence-based practices for childbirth. This should include proper assessment of maternal distress and the appropriate use of caesarean sections, emphasizing the importance of non-medical interventions whenever possible.

3. Addressing Maternal Fear and Pain: Implement strategies to address maternal fear and pain during childbirth. This can involve the use of pain management techniques, such as epidurals or other non-pharmacological methods, to reduce the perceived need for caesarean sections due to fear and pain.

4. Ethical Guidelines and Oversight: Develop and enforce ethical guidelines for healthcare providers to ensure that caesarean sections are only performed when medically necessary. Establish oversight mechanisms to monitor and evaluate the appropriateness of caesarean section procedures, reducing the risk of non-medically-justified surgeries.

5. Community Engagement and Education: Conduct community awareness campaigns to educate women and their families about the benefits and risks of caesarean sections. Promote the importance of seeking timely and appropriate maternal healthcare services, including antenatal care, to reduce the need for emergency interventions.

6. Collaboration and Partnerships: Foster collaboration between healthcare institutions, government agencies, and non-governmental organizations to pool resources and expertise in addressing the issue of increased recourse to caesarean sections. This can include sharing best practices, conducting research, and implementing innovative solutions.

By implementing these recommendations, it is possible to improve access to maternal health services, reduce non-medically-justified caesarean sections, and ultimately decrease maternal mortality rates in Benin and Mali.
AI Innovations Methodology
To improve access to maternal health in Benin and Mali, here are some potential recommendations:

1. Strengthening healthcare infrastructure: Invest in improving and expanding healthcare facilities, particularly maternity wards, to ensure they are adequately equipped and resourced to handle childbirth complications and emergencies.

2. Training and capacity building: Provide comprehensive training programs for healthcare providers, including obstetricians and midwives, to enhance their skills in managing labor and delivery, including the appropriate use of caesarean sections.

3. Community outreach and education: Conduct awareness campaigns to educate women and their families about the importance of antenatal care, safe delivery practices, and the potential risks and benefits of caesarean sections. This can help dispel myths and misconceptions and encourage informed decision-making.

4. Strengthening referral systems: Establish effective referral networks between primary healthcare centers and higher-level facilities to ensure timely access to appropriate care for women with high-risk pregnancies or complications.

5. Addressing financial barriers: Implement policies and programs to reduce financial barriers to maternal healthcare, such as providing subsidies or insurance coverage for caesarean sections, particularly for women from low-income backgrounds.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data collection: Gather relevant data on the current state of maternal health, including caesarean section rates, healthcare infrastructure, healthcare provider capacity, and access to maternal healthcare services.

2. Modeling: Develop a simulation model that incorporates the various factors influencing access to maternal health, such as healthcare infrastructure, provider capacity, community awareness, and financial barriers. This model should be based on available data and evidence-based assumptions.

3. Scenario analysis: Use the simulation model to analyze different scenarios based on the potential recommendations. For example, simulate the impact of strengthening healthcare infrastructure by increasing the number of adequately equipped maternity wards or the impact of implementing financial support programs for caesarean sections.

4. Evaluation: Assess the simulated impact of each scenario on improving access to maternal health, considering indicators such as caesarean section rates, maternal mortality rates, and healthcare utilization. Compare the outcomes of different scenarios to identify the most effective interventions.

5. Policy recommendations: Based on the simulation results, provide evidence-based recommendations for policymakers and stakeholders on the most effective strategies to improve access to maternal health in Benin and Mali.

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