9. C-Sections as a Nefarious Plot: The Politics of Pronatalism in Turkey
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122 9 C-Sections as a Nefarious Plot The Politics of Pronatalism in Turkey Katrina MacFarlane The Rise of the Cesarean Since the advent of its use in the nineteenth century, the Cesarean section (C-section) has been a cornerstone of maternal and neonatal health. Although the origins of the Cesarean date back well before the 1800s, the procedure became largely successful at decreasing maternal and infant mortality only toward the latter half of the nineteenth century, with the onset of medical techniques such as stitching the uterine incision and providing anesthesia during the procedure (Van Dongen 2009). As physicians developed new strategies to limit sepsis during surgery, maternal mortality associated with the C-section continued to drop in the early twentieth century. The common thread during its early historical use was that the C-section was a last resort, medically indicated only when the dangers of a traditional vaginal delivery far exceeded the risk of a Cesarean. To this day, C-section remains the optimal mode of delivery in cases where vaginal delivery is risky or not possible, as in cases of abnormal fetal position, fetal distress, or prolonged labor (World Health Organization 2015a). What originally emerged as a life-saving procedure has evolved a complex and multifaceted social, cultural, and political identity in the twenty-first century . The Cesarean is considered underutilized in some regions, most notably in sub-Saharan Africa, where it often represents less than 5 percent of all deliveries (Gibbons et al. 2010). Simultaneously, Cesareans represent half or more of all deliveries in countries such as Brazil and Turkey. Italy, China, and Iran have also reported significant overuse of the medical procedure. By the mid-2000s, the C-section was the most commonly performed surgery among women in the United States (DeFrances and Hall 2007). The resulting dichotomy of provision suggests that Cesareans are no longer deemed an emergent medical procedure by much of the world, and in some contexts they are C-Sections as a Nefarious Plot   123 used electively, on the basis of the physician’s preference, the woman’s preference , or both. The use of the procedure, which still represented a minority of deliveries internationally into the early 1990s, has grown at an unprecedented pace across many developed and developing nations in the last two decades. Although a C-section can be medically indicated for a number of reasons, increased maternal and neonatal health risks are associated with Cesarean provision; neonatal respiratory problems, for example, are more common after a C-section delivery (Ramachandrappa and Jain 2008). Further, complications tend to increase with multiple pregnancies; complications increase in vaginal birth after Cesarean section (VBAC), and repeat C-sections come with increased incidence of uterine rupture, placenta accreta, and placenta previa (Boutsikou and Malamitsi-Puchner 2011). As a result, clinicians and policy makers around the world have called for countries with a high Csection prevalence to decrease Cesarean provision and have discouraged the performance of elective—that is, not medically indicated—C-sections (World Health Organization 2015a). Until recently the World Health Organization (WHO) recommended a Cesarean prevalence of 5 percent to 10 percent, with an upper limit of 15 percent, to optimize maternal and child health (World Health Organization 1985). Another vital consideration is cost. C-sections are generally more expensive to provide than vaginal delivery; therefore nations that provide substantial numbers of Cesareans require additional funding for a medical procedure that, in many cases, is not needed (Gibbons et al. 2010). Although some researchers argued that the 10 percent to 15 percent target is not optimal, or even realistic, to achieve, recent studies with an emphasis on maternal and neonatal health outcomes have supported these findings and suggest that international public health programs should aim to lower C-section provision to below 15 percent or to maintain it below that level (Althabe and Belizán 2006).1 Countries have tried to combat the increasing trend in a variety of ways. As new findings demonstrate that the majority of women can have successful and safe vaginal deliveries even with a previous C-section delivery, some countries, such as the United States, have revised obstetrical guidelines to encourage more women to pursue VBAC (O’Callaghan 2010). There are also educational measures in place for physicians and patients to decrease the incidence of first-birth C-section in low-risk pregnancies. Once a woman has a primary C-section delivery, she is more likely to have a C-section for subsequent deliveries, so this...

Subject Headings

  • Human reproductive technology -- Middle East.
  • Human reproductive technology -- Africa, North.
  • Birth control -- Middle East.
  • Birth control -- Africa, North.
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