September 20, 2024 – RANA HENDY AND LOBNA SHAHEEN

CAIRO – Egypt, renowned for its vibrant culture and rich history, has fallen on hard times, grappling with both a faltering economy and a deteriorating health system. An alarming surge in births by cesarean section is emblematic of this decline, exposing deep-seated inequalities within the country’s health-care sector.

The percentage of C-sections in Egypt has skyrocketed over the past decade, from 52% of all births in 2014 to a staggering 72% in 2021, according to the Egypt Family Health Survey. This means that Egypt currently has the world’s fourth-highest share of C-sections – nearly five times the World Health Organization’s recommended rate of 10-15%.

To be sure, C-sections have surged across the Middle East and North Africa (MENA) in recent years. Rates in Saudi Arabia, the United Arab Emirates, and Jordan, for example, stand at 35%, 40%, and 30%, respectively.

Beyond the MENA region, C-section rates vary widely. In the United States, C-sections account for more than 32% of births, while rates among the European Union’s 27 member states are between 16% and 52%. Nevertheless, the underlying drivers are often similar, with medical practices, patient preferences, and legal concerns all contributing to the prevalence of surgical deliveries.

In Egypt, however, the problem is exacerbated by economic instability, insufficient health-care funding, and an overreliance on private providers. This combination distorts incentives, favoring surgical deliveries and propelling the country to the top of global rankings. In 2017, household out-of-pocket payments accounted for 56% of all health-care financing, well above the 40% average for low- and lower-middle-income countries.

These trends are primarily driven by Egypt’s ongoing economic crisis. High inflation, currency devaluation, and reduced government spending on public services have adversely affected the affordability and accessibility of health care.

The consequences of Egypt’s C-section surge extend far beyond the immediate health risks to mothers and infants. The long-term effects include an increased likelihood of complications in future pregnancies, elevated maternal mortality rates, and an increasingly strained health system. Moreover, the country’s economic turmoil has placed significant pressure on private health-care providers, leading many to prioritize efficiency and financial gain over patient-centered care.

This, in turn, has fostered a profit-driven approach within the health-care sector, where C-sections are increasingly viewed as the more lucrative option. A 2017 study found that women giving birth in private hospitals were more likely to undergo C-sections compared to those delivering in public ones, with the rate of C-sections in private facilities more than quadrupling between 2005 and 2014.

The rise in C-sections in private hospitals can be attributed to several factors, including noncompliance with government regulations, inadequate law enforcement, and the public’s preference for private facilities boasting advanced medical technologies and superior patient care – especially in cases of anticipated birth complications. Obstetricians also tend to favor procedures that enable them to manage their schedules more efficiently.

Despite the higher costs and health risks, C-sections are increasingly seen as the more convenient and safer choice, owing to the widespread perception that doctors prefer them. According to a 2015 survey by the Egyptian Ministry of Health, eight of ten married or previously married women aged 15-49 who are familiar with cesarean deliveries believe doctors favor these procedures. Thus, in a country where out-of-pocket expenses constitute a majority of health-care spending, many families feel compelled to opt for costly – and often unnecessary – C-sections performed by private providers.

This underscores the urgent need for comprehensive health-care reforms to ensure equitable access to high-quality obstetric care, regardless of socioeconomic status. Tackling the surge in C-sections requires a multifaceted approach that combines economic and educational interventions, along with government investment in infrastructure and the adoption of evidence-based obstetric guidelines. Equally important are public-awareness campaigns aimed at educating people, especially expectant mothers, about the risks and benefits associated with various delivery methods.

By taking decisive steps to address the economic and systemic issues driving the rise in C-sections, Egypt can begin to restore balance to its health-care sector and ensure that childbirth remains a safe and healthy experience for all women and newborns.

Rana Hendy is Assistant Professor of Economics and Public Policy at the American University in Cairo.

Lobna Shaheen is a Master of Public Policy candidate at the American University in Cairo.

Previously published on Project Syndicate on September 11, 2024.

Copyright: Project Syndicate, 2024.
www.project-syndicate.org

Photo by Bruno Curly: https://www.pexels.com/photo/doctor-holding-newborn-leg-over-paper-19963969/