Gender Differentiated Attitude Towards Cesarean Section: A Case of Somali Refugees in Dadaab, Kenya

Abstract

Caesarean section (CS) is the most commonly performed obstetrical surgery for life-saving and prevention of delivery complications.The World Health Organization (WHO) recommends a Caesarean section rate of between 10 and 15% as an acceptable level.However, studies have suggested that African women have an aversion for CS preferring vaginal delivery to caesarean section even when there is need to address basic obstetric complications; they perceive CS as being dangerous to the mother and baby.The inadequate use of CS in African countries has been identified as a key factor in the continuing high rates of maternal and perinatal morbidity in the region.In light of non-acceptance of CS among women in many developing countries, this study sought to explore gendered differentiated attitude towards CS among Somali Refugees who seek the services of Traditional birth attendants (TBA) in Dadaab.A qualitative case research design was employed with Ten Traditional Birth Attendants (TBAs), 3 pregnant women, 2 men and 2 refugee safe mothers who were Purposively selected from IFO refugee camp in Dadaab, Kenya.Additional responses were sought from 10 Nurses and 15 mothers in Red Cross hospital in IFO camp.Data was collected through in-depth interviews and personal observations.The study found that both men and women were reserved about CS expressing fear of death.Women also avoided CS due to fear of facing rejection from their husbands, psychological and emotional trauma of being stigmatized by the community; men felt that their conjugal rights were restricted if their women went through CS.They also indicated that TBAS are fellow women who help mothers to deliver at home, while in hospitals CS is done by men which is against the Somali culture.These findings indicate that there are many perceptions about CS among refugee community and thus need for programs to increase community understanding of CS as a method of delivery.The findings may also be a valuable process indicator for identifying the gaps in obstetric care that can be used for advocating improvements for healthcare. BackgroundCesarean section (CS) is the most commonly performed surgery in obstetrical care.It can be life-saving and is also a highly effective procedure for preventing delivery complications.The World Health Organization (WHO) has recommended a Caesarean section rate of between 10 and 15% (average 12.5%) as an acceptable level.This recommendation has formed the basis on which Caesarean rates have been considered normal, low or high [1].WHO in 2015 further stated that every effort should be made to provide CS to women in need, rather than striving to achieve a specific rate.Despite recommendation by WHO studies have revealed that Caesarian section have continued to increase in an unprecedented manner.Studies shows that in many cases cesarean section is not always necessitated by medical reasons but lack of awareness, false beliefs and behaviors determine the method of delivery, i.e. giv-ing priority to cesarean delivery roots in psychological, social, and cultural factors [2].In addition [3] in many societies, cesarean has converted to a cultural issue and more than half of the women choose cesarean delivery voluntarily.Each year 1.5 million childbearing women have cesarean deliveries, and this population continues to increase [4].A global survey conducted in 2012 showed that there was a CS rates of 19.8 % in Japan and 32.8 % in USA while in a report of 2011 the average CS rate of 18 European Union member states was 26.8% [5].The rise in CS rates in middle-income countries, such as Argentina and Paraguay, has been found to be faster in recent decades than that in high-income countries.The CS rates in large Chinese cities with populations over 100 million rose from 10.12% to 63.0% between 1993 and 2008 [5].In south Africa there has been a trend of increasing frequency, acceptance, and popularity of Cesarean sections.Noting that Eighty