Santas Gulcan, Santas Fatih
a Department of Health Management , Hacettepe University , Ankara , Turkey.
b Department of Health Management , Bozok University , Yozgat , Turkey.
J Obstet Gynaecol. 2018 Jul;38(5):658-662. doi: 10.1080/01443615.2017.1400525. Epub 2018 Mar 8.
The aims of this study was to determine the trends in rates of caesarean sections in Turkey. The data source for this study was the Turkey Demographic and Health Survey (TDHS) 1993-1998-2003-2008-2013 conducted by Hacettepe University, Institute of Population Studies. Cross tables and binary logistic regression were used for analysis. It was found that the caesarean section rate, which was 14.3% in 1993, increased to 51.9% in 2013. The rate increased with maternal age and educational level at childbirth. The Caesarean section rate was higher in women who were under health insurance coverage, first time mothers, childbirth in the private health institutions, those staying in the Western region and urban areas, and having the highest level of wealth. This study aims to contribute to the literature of caesarean sections especially in developing countries, in which caesarean section has become a major healthcare issue. Impact Statement What is already known on this subject: Caesarean section is among the most widely practiced obstetric surgery worldwide. Previous studies have suggested that the rates of caesarean section were affected by the biological, genetic and medical factors. What the results of this study add: Besides the biological, genetic and medical factors, it is believed that social factors (income and social status, education, employment, etc.) play an important role on the caesarean section in developing countries. Although the laws on caesarean sections have been enforced since 2012 in Turkey, this study shows that there has been a significant increase in caesarean section between the 1993 and 2013 periods. The study also reveals that prohibiting caesarean sections, except in cases of medical necessity, is a problematic issue in the health system despite all efforts. What the implications are of these findings for clinical practice and/or further research: This study may be of interest for authorities and researchers in terms of showing the social factors associated with the caesarean section.
本研究的目的是确定土耳其剖宫产率的变化趋势。本研究的数据来源是由哈杰泰佩大学人口研究所在1993 - 1998 - 2003 - 2008 - 2013年进行的土耳其人口与健康调查（TDHS）。采用交叉表和二元逻辑回归进行分析。研究发现，剖宫产率在1993年为14.3%，到2013年增至51.9%。该比率随产妇年龄和分娩时的教育水平升高而增加。在享有健康保险、初产妇、在私立医疗机构分娩、居住在西部地区和城市地区以及拥有最高财富水平的女性中，剖宫产率更高。本研究旨在为剖宫产文献做出贡献，尤其是在剖宫产已成为主要医疗保健问题的发展中国家。影响声明关于该主题已有的认识：剖宫产是全球应用最广泛的产科手术之一。先前的研究表明，剖宫产率受生物学、遗传和医学因素影响。本研究结果补充了什么：除生物学、遗传和医学因素外，人们认为社会因素（收入和社会地位、教育、就业等）在发展中国家的剖宫产中起重要作用。尽管土耳其自2012年起实施了剖宫产相关法律，但本研究表明，在1993年至2013年期间剖宫产率仍显著上升。该研究还揭示，尽管已做出所有努力，但在医疗必需情况以外禁止剖宫产在卫生系统中仍是一个有问题的议题。这些发现对临床实践和/或进一步研究的意义是什么：本研究在展示与剖宫产相关的社会因素方面，可能会引起当局和研究人员的兴趣。
