C-Sections in El Salvador

I recently heard from a friend who has lived in El Salvador for a number of years that C-sections for first time mothers occur at a very high rate in government hospitals. These women with a C-section history are told that in subsequent pregnancies a natural birth would be too risky, and that more than three C-sections in also inadvisable. Presto. Family size limited to three children--among the poor who can not afford private hospitals.

It gets worse. Reportedly, the United Nations pays for C-sections. This could mean that government hospitals have a financial incentive to perform C-sections because they have guaranteed income from doing so.

My friend recounted stories of personal acquaintances of hers who were positive that their C-sections were not necessary. In one case, the mother was told that "the doctor needed to get home before midnight" and this was taking too long. She protested, but a laboring woman is not physically able to resist a knife or ether-wielding medical practitioner, and the C-section took place over her protests.

In another case, an expectant mother, under the care of a person who had worked in a birthing center, labored in a vehicle in the parking lot of a hospital till the baby was so close to being born that there would be no time for a C-section. Then she went into the hospital and had her baby within minutes. Congratulations were not forthcoming. The mother was greeted with very noticeable anger. She was subjected to a D & C which was almost certainly not needed--to check that everything was alright.

Hearing these stories aroused my ire. After I had a bit of time to cool down I tried to learn what I could, to see if it's possible to corroborate this information from other sources. I did not find positive proof that UN money is deliberately used in El Salvador to perform unnecessary C-sections for the purpose of population control. Cynically, I presume that it would never be posted for all to see if such were the case, so it's hardly surprising that the proof is hard to find.

Here's what I did find:

1) A publication from the El Salvador government Ministry of Public Health and social welfare says: "The incidence of cesarean section deliveries under the Ministry increased from 20.0% of all deliveries in 1992 to 22.9% in 1996." Note that these statistics are at least 15 years old, the rate did not increase dramatically in that time period. Note also that in other sources any percentage over 15% is considered excessive.

Note: Blogger has swallowed whole the last half of this post. I'll see if I can recover or reconstruct the remainder at a later time. If I have to rewrite everything, I'll have to recover a bunch of source documents that were referenced here. Bummer.