Caesarean section and subsequent fertility in sub-Saharan Africa

BJOG. 2006 Mar;113(3):276-83. doi: 10.1111/j.1471-0528.2006.00846.x.

Abstract

Objective: To determine the impact of caesarean section on fertility among women in sub-Saharan Africa.

Design: Analysis of standardised cross-sectional surveys (Demographic and Health Surveys).

Setting: Twenty-two countries in sub-Saharan Africa, 1993-2003.

Sample: A total of 35 398 women of childbearing age (15-49 years).

Methods: Time to subsequent pregnancy was compared by mode of delivery using Cox proportional hazards regression models.

Main outcome measures: Natural fertility rates subsequent to delivery by caesarean section compared with natural fertility rates subsequent to vaginal delivery.

Results: The natural fertility rate subsequent to delivery by caesarean section was 17% lower than the natural fertility rate subsequent to vaginal delivery (hazard ratio = 0.83, 95% CI 0.73-0.96, P < 0.01; controlling for age, parity, level of education, urban/rural residence and young age at first intercourse). Caesarean section was also associated with prior fertility and desire for further children: among multiparous women, an interval > or =3 versus <3 years between the index birth and the previous birth was associated with higher odds of caesarean section at the index birth (OR = 1.4, 95% CI 1.1-1.7, P= 0.005); among all women, the odds of desiring further children were lower among women who had previously delivered by caesarean section (OR = 0.67, 95% CI 0.54-0.84, P < 0.001). Caesarean section did not appear to increase the risk of a subsequent pregnancy ending in miscarriage, abortion or stillbirth.

Conclusions: Among women in sub-Saharan Africa, caesarean section is associated with lower subsequent natural fertility. Although this reflects findings from developed countries, the roles of pathological and psychological factors may be quite different because a much higher proportion of caesarean sections in sub-Saharan Africa are emergency procedures for maternal indication.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara / epidemiology
  • Attitude to Health
  • Birth Rate
  • Cesarean Section / adverse effects
  • Cesarean Section / statistics & numerical data*
  • Contraception / statistics & numerical data
  • Cross-Sectional Studies
  • Decision Making
  • Educational Status
  • Female
  • Humans
  • Infertility, Female / epidemiology
  • Infertility, Female / etiology*
  • Middle Aged
  • Mothers / psychology
  • Parity
  • Pregnancy
  • Risk Factors
  • Sterilization, Reproductive / statistics & numerical data