Identification of factors influencing the rise of cesarean sections rates in Pakistan, using MCDM.

PURPOSE: The rate of cesarean sections has been rapidly increased in the last few decades in all the developing as well as developed countries. The rate of cesarean sections determined by the World Health Organization has been crossed by many countries, like Brazil, India, China, USA, Australia, etc. Similarly, this rate has also increased in Pakistan. The purpose of this paper is to explore and identify the factors that are responsible for the rising rate of cesarean sections in Pakistan.

DESIGN/METHODOLOGY/APPROACH: These factors are categorized under medical and non-medical factors. The medical factors include the obesity of mother, age of mother, weight of the baby, umbilical cord prolapse, fetal distress, abnormal presentation, dystocia and failure to progress. The non-medical factors include financial incentives of doctors, time convenience for doctors, high tolerance to surgery, patient's preference toward cesarean section, private hospitals, public hospitals, income status of patients, rural areas, urban areas and the education of patients. To identify the critical factors, data have been collected and a multi-criteria decision-making technique, called Decision Making Trial and Evaluation Laboratory, is used.

FINDINGS: The result shows that the medical factors that are responsible for the rise in the rate of cesarean sections are umbilical cord prolapse, age of mother and obesity of mother. On the other hand, the non-medical factors that are the reasons for the increase in cesarean sections are the large number of private hospitals and the unethical acts of the doctors in these hospitals, preference of patients, and either the unavailability of doctors or poor conditions of hospitals in rural areas.

ORIGINALITY/VALUE: Cesarean section is an important surgical intervention and is considered to be very essential in the cases of existing as well as potential medical problems to the mother or the baby. Cesarean section is also performed for non-medical reasons. In Pakistan, the number of private hospitals has increased and these hospitals provide good health care. However, these hospitals do not work under the rules and regulations set by the government. The doctors in private hospitals perform unnecessary cesarean sections in order to fulfill the demands of private hospital's owners. In addition to this, it is also found that, nowadays, most women prefer to give birth through cesarean section in order to eliminate the pain of normal vaginal delivery.