CONGO: A cut too far? C-sections increase after policy change

BRAZZAVILLE, 15 September 2011 (IRIN) - A health policy shift that saw the introduction in May of free Caesarean section operations in 35 hospitals across the Republic of Congo - to curb the growing rate of maternal and infant mortality - seems to have prompted a proliferation of such operations, according to health officials.

"We are virtually living in the hospital because there are so many consultations," said Jean-Claude Kala, head of gynaecology at Makélékélé Hospital, south of Brazzaville. “The free service has helped many people because until very recently many women were dying because their husbands or their parents had no money to pay for a Caesarean."

Congo's health authorities introduced the free Caesarean sections to reduce a maternal mortality rate considered high. Officially it is 781 deaths per 100,000 live births. One in 28 women dies in childbirth.

In 2010, Kala said, 5 percent of the 10,000 births in the hospital were by Caesarian; "so far this year we have had fewer than 6,000 births, but 10 percent of them were by Caesarean. This shows that the rate is increasing in our hospital."

Makélékélé Hospital is one of the designated centres in Brazzaville where the free operations are available.

Between May and August, some 220 Caesarean sections and 29 obstetric operations were carried out, according to Kala, even though the hospital has only 150 beds and three gynaecologists.

Before the new policy, the cost of a Caesarean was 50,000-150,000 CFA francs (US$100-$300) in a country where it is estimated 70 percent of the population lives below the poverty line.

"We reckon there are more cases than before. But we should also note the decline in mortality of both women and children," Jean Louis Lengouango, director of Talangaï Hospital in the sixth district of Brazzaville, told IRIN.

Congo is a poor country. People are interested in anything offered for free“We have not seen any break in supplies of medical equipment since the scheme was introduced because we are regularly replenished by the Director of Studies and Planning of the Ministry of Health," said Lengouango, adding that all the doctors involved were state-funded.

A commission set up to evaluate the scheme estimates it will cost more than 2.8 billion CFA francs ($5.9 million) in 2011. Between May and August, the commission recorded 1,779 Caesarean deliveries out of 15,211 births, with 14 maternal deaths and 83 neonatal deaths.

"Congo is a poor country. People are interested in anything offered for free. For the moment it is difficult to assess the value of the measure. I think that after a few years it will show its limits," Paul Ngangoue, 71, told IRIN.

The UN Population Fund (UNFPA) is one of the partners supporting the initiative.

"We believe that free Caesarean sections and the promotion of family planning are among the elements that contribute to reducing deaths by 60 percent," said Jean René Kule, head of advocacy at UNFPA in Brazzaville. "It's an initiative that we want to see continued."