“Inne-CESAREA”: A Spanish language campaign against unnecessary cesareans

6 Mar

Our thanks to Ana M. Parrilla-Rodríguez, MD, MPH, FABM, LCCE, professor of Maternal and Child Health, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico for contributing this blog post.

Statistics show that Puerto Rico continues with one of the highest cesarean section rates in the world. During the last thirty years the percentage of cesarean deliveries on the island has increased drastically from 18.2% in 1980 to 46.3% in 2010. For the last five years we have annually tripled the World Health Organization (WHO) statement that there is no reason for any country to have a cesarean section rate over 15%. This is a significant public health problem which affects, among other things, the health of Puerto Rican mothers and their babies.

In the face of this reality, the inne-CESAREA campaign has been launched. It is an initiative of the Association of Students of Maternal and Child Health at the Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus. It strives to promote the empowerment of Puerto Rican women through an educational campaign for the prevention of unnecessary cesarean sections. The multi-media educational campaign is appealing, up- to-date and approved by public health experts. It  promotes the humanization of childbirth and its benefits for the health of mothers and babies. It means to address a severe public health problem represented by the unacceptably high cesarean section rates and unnecessary interventions used during labor and birth on mothers and babies.

Campaign director Javier Morales-Nazario, student in the Maternal and Child Health Program, states, “We invite mothers, their partners and relatives to embrace a different experience, where childbirth is seen as a natural process which is beautiful and full of energy.”

“A new chapter has begun in the struggle for humanized childbirth in Puerto Rico. We hope to see changes in maternal and child health care. It is time for women to be the principal decision-makers in what really belongs to them-childbirth,” adds Morales-Nazario.

This public education project encourages women to make their own decisions for themselves and  their babies. Its motto reads: “Decide for yourself, be the protagonist, take control. It includes a theme song and Hip-Hop video, a web page, presence in the social networks Facebook and Twitter, as well as educational posters and fliers. It has been endorsed and supported by over twenty local and international organizations in an effort named “inne-CESAREA Alliance”. It has received support from many people in other Spanish-speaking countries and Amnesty International is working to unite its affiliates in Latin America to join the campaign. Work is being done to caption the video in Portuguese, French, English and sign language.

To view the campaign materials in Spanish visit www.inne-CESAREA.org.

To view the campaign materials in English (a Google translation) visit www.inne-CESAREA.org.

3 Responses to ““Inne-CESAREA”: A Spanish language campaign against unnecessary cesareans”

  1. Jose J. Gorrín-Peralta March 29, 2012 at 2:59 pm #

    The debate over the desirable cesarean section levels in a given country has persisted since the 1985 WHO statement, coming from the Fortaleza, Brazil, meeting on the use of technology for the optimal care of the pregnant woman. The WHO document from 2009 cited in the previous post makes it clear that minimum and maximum acceptable cesarean section rates of 5% and 15% are based on the best data, estimates and assumptions currently available. It is very difficult to give an absolute figure which could rigidly apply to all countries, with the vast differences in socioeconomic development, health care infrastructure, professional resources, geographic extension etc. The cited WHO document from 2009 maintains that the 15% is a threshold not to be exceeded, as well as expressing concern about unduly low rates of cesarean section rates seen in several countries with poor maternal and child health indicators. It also expresses concern about the accumulating evidence of the negative consequences for mother and child of cesarean delivery, and its impact, when the cesarean section rates are much higher than 15%, on maternal and neonatal morbidity and mortality. The literature on this theme states that when the cesarean section rate rises substantially above 15% the risks to reproductive health outcomes begin to outweigh the benefits.

    The work by Betrán et al (2007) states that countries with relatively high maternal and neonatal death rates, when cesarean rates are sharply above the referenced range, may want to investigate whether their systems are delivering medically appropriate obstetrical care and prioritize a monitoring strategy for cesarean section rates and mortality and morbidity rates. In Puerto Rico we are dealing with precisely that problem, a cesarean section rate of 46-49%, in the face of unacceptably high rates of preterm births, low birth-weight and maternal mortality. The inne-cesarea.org campaign is intended to raise people’s consciousness and create awareness of this problem, and promote empowerment for women of reproductive age of what amounts to the most severe public health problem for this population.

    Betran AP, Meriald M, Lauer JA, Bing-Shun W, Thomas J, Van Look P, Wagner M. Rates of caesarean section: analysis of global, regional and national estimates. Paediatric and Perinatal Epidemiology, 2007;21:98-113.

    José J. Gorrín-Peralta, MD, MPH, FACOG

  2. Becky March 26, 2012 at 11:17 am #

    The WHO no longer states that there is no reason to have a cesarean rate over 15%. In fact, they state that their previous recommendation was not based on empirical evidence, and that there is no evidence for any particular ideal rate of cesareans. In their discussions about cesareans, while they not that too high a rate may do more harm than good, most of the discussion is focused on access to cesareans, not lowering the rate. See here on page 25 for the discussion of Cesearean Section rates: http://whqlibdoc.who.int/publications/2009/9789241547734_eng.pdf

    On page 38 they also cite evidence that the 15% maximum may have been based on a false assumption about the rates of serious obstetrical complications.

    • Nicette March 29, 2012 at 1:25 pm #

      Hello, Becky

      I reviewed the WHO document and did not find that they rescinded their recommendations for country cesarean rates. In this document, the WHO is concerned that some women dye needlessly because they don’t have access to a cesarean for medical reasons.

      Henci Goer responded to a similar viewpoint about the WHO’s recommendations in her blog post for Science & Sensibility a couple of years ago. You can read her well-documented response, “Does It? Really? “WHO Admits: There Is No Evidence for Recommending a 10-15% Caesarean Limit” posted on October 30th, 2009 at http://www.scienceandsensibility.org/?p=483.

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