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Caesarean section and subsequent fertility in sub-Saharan Africa.
BJOG 2006; 113(3):276-83BJOG

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.

Authors+Show Affiliations

Maternal Health Group, Infectious Disease Epidemiology Unit, Department of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK. simon.collinlshtm.ac.ukNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

16487198

Citation

Collin, S M., et al. "Caesarean Section and Subsequent Fertility in sub-Saharan Africa." BJOG : an International Journal of Obstetrics and Gynaecology, vol. 113, no. 3, 2006, pp. 276-83.
Collin SM, Marshall T, Filippi V. Caesarean section and subsequent fertility in sub-Saharan Africa. BJOG. 2006;113(3):276-83.
Collin, S. M., Marshall, T., & Filippi, V. (2006). Caesarean section and subsequent fertility in sub-Saharan Africa. BJOG : an International Journal of Obstetrics and Gynaecology, 113(3), pp. 276-83.
Collin SM, Marshall T, Filippi V. Caesarean Section and Subsequent Fertility in sub-Saharan Africa. BJOG. 2006;113(3):276-83. PubMed PMID: 16487198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Caesarean section and subsequent fertility in sub-Saharan Africa. AU - Collin,S M, AU - Marshall,T, AU - Filippi,V, PY - 2006/2/21/pubmed PY - 2006/5/17/medline PY - 2006/2/21/entrez SP - 276 EP - 83 JF - BJOG : an international journal of obstetrics and gynaecology JO - BJOG VL - 113 IS - 3 N2 - 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. SN - 1470-0328 UR - https://www.unboundmedicine.com/medline/citation/16487198/Caesarean_section_and_subsequent_fertility_in_sub_Saharan_Africa_ L2 - https://doi.org/10.1111/j.1471-0528.2006.00846.x DB - PRIME DP - Unbound Medicine ER -