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Axe1 - Santé et Genre

CESARIA • Determinants of caesarean section : a multicenter study (Benin, Cambodia, France, Mali, Viet Nam)

Responsables scientifiques

Partenariat

  • Calmette hospital, Phnom Penh, Cambodia, http://www.calmette.gov.kh/
  • Centre de Santé de Référence de la Commune II, Bamako, Mali
  • Centre Hospitalier Intercommunal (CHI) de Poissy Saint Germain
  • Centre Hospitalo -Universitaire de la Mère et de l’Enfant-Lagune (CHU MEL), Cotonou, Bénin
  • Centre Hospitalo-Universitaire (CHU) du Borgou, Parakou, Bénin
  • Clinique Biosso, Abomey Calavi, Bénin
  • Clinique ALMED, Bamako, Mali
  • Dassa Zone hospital, Benin
  • Direction Nationale de la Santé (DNS), Ministère de la Santé et de l’Hygiène Publique, République du Mali
  • Institute of Population and Social Studies, National Economics University, Hanoi, Vietnam, http://en.neu.edu.vn/
  • Maison des Sciences de l’Homme de Paris Nord, http://www.mshparisnord.fr/
  • National hospital of Obstetrics and Gynecology, Hanoi, Vietnam , http://benhvienphusantrunguong.org.vn/news/trang-chu
  • Nianankoro Fomba hospital, Segou regional hospital, Mali
  • Sikasso regional hospital, Mali
  • Somine Dolo hospital, Mopti, Mali
  • Reproductive Health Department of Ministry of Health, Hanoi, Vietnam, http://mch.moh.gov.vn/
  • Sorphear clinic, Phnom Penh, Cambodia, https://www.facebook.com/pages/Sophea-Maternity-Clinic/286135574737062

Membres du CEPED participant au projet

  • Marion Ravit, doctorante
  • Luu Bich Ngoc, chercheure associée

Financement

Résumé

When medically justified, caesarean section can effectively prevent maternal and perinatal morbidity and mortality, but there is no benefit to perform it in more than 10% of deliveries as it involves risks (Bertran et al. 2015). The increase in the rates of caesarean section worldwide is therefore a global health issue that goes beyond national borders and raises many debates.
This study aims to improve our understanding of the different factors determining the rates of caesarean section. This knowledge will help develop better targeted interventions to reduce or control the rate of caesarean section. The main hypothesis of this research is that the practice of Caesarean section is the result of interactions between biomedical, behavioral and institutional factors at the community, collective and individual levels. Not all these reasons are understood today. They form a complex set that includes among others : characteristics of the health system, medical staff and pregnant women, economic and socio-cultural context, and the influence of the media (Betran et al. 2015).
Since the 2000s, several authors have attempted to deconstruct this request for caesarean section in different countries of the world (Gamble et al. 2007) (Brugeilles 2014). Most of these studies have been performed in Brazil (Hopkins 2000) (Osis et al. 2001) (Béhague et al. 2002) (Diniz et Chacham 2004), Australia (Fenwick et al. 2010), United States (Wagner 2000), China (Lo 2003), and Tanzania, a low income country where caesarean section rates have increased recently (Litorp et al. 2015). Thus, caesarean section rates at national level reflect the matching of medical supply and social demand. This locus is characterized by gender relations and social classes (Brugeilles 2014). It seems necessary to update our knowledge by analyzing in a more systematic and in-depth way the social, cultural, demographic and biomedical determinants of cesarean section.
The approach is that of a “multiple case-study” in fifteen study sites and 5 countries : Benin, Cambodia, France, Mali and Vietnam. These countries reflect the diversity of settings around the world. Within each country, we select a diversity of settings including both private and public health care facilities. The project is multidisciplinary as it involves obstetricians, midwives, demographers, epidemiologists, qualitative social scientists, as well as hospital managers and policy-makers in the national ministries of health. Relevant stakeholders (clinicians and patients/families) and end-users of the research (ministries of health, hospital and service managers, and health workers) are involved throughout the project. For this type of multidisciplinary study, researchers adopt a pragmatic position to answer research questions and provide recommendations to decision makers. The in-depth research strategy and use of multiple sources of evidence reinforce the internal validity of the case studies (all hospitals). We organize inter-case analyses and communication as a stepwise process. For each of these steps, researchers move to a higher level of analytical generalization. This collective process aims at strengthening the validity of the conclusions.

Mots-Clés
Cesarean section, delivery, maternal health, determinants, medicalization

Zone géographique
Benin, Cambodia, France, Mali, Vietnam

Calendrier
This study has started in January 2017 for three years.
An international workshop on the medicalization of delivery will be organized in Paris in December 2017 to discuss the first results.

Contact
Alexandre.Dumont chez ird.fr
Myriam.de-Loenzien chez ird.fr
clemschantz chez hotmail.com

Résultats et valorisation
This study is underway.