Camille Etcheverry (midwife and doctoral student in epidemiology with the QUALI-DEC project), will publicly present her doctoral thesis defense in public health on November 21, entitled: “Mode of delivery in low- and middle-income countries: non-clinical factors influencing decision-making “, under the supervision of Alexandre Dumont (gynecologist-obstetrician, research director at IRD, researcher at Ceped-Université Paris Cité and scientific coordinator of the QUALI-DEC project).
Open to the public, the defense will take place on Thursday, November 21, 2024 at 2pm at the Université Paris Cité – Campus des Saints-pères (Paris 6ème ) and will include the following members of the jury:
- Valérie BRIAND, Research Director, Epicentre/MSF, Rapporteur
- Véronique FILIPPI, full professor, London School of Hygiene and Tropical Medicine, Rapporteur
- François GOFFINET, University Professor, Université Paris Cité, Examiner
- Henri-Jean PHILIPPE, University Professor, Université Paris Cité, Guest Member
- Ana Pilar BETRAN LAZAGA, medical officer, WHO, Guest Member
- Alexandre DUMONT, Research Director, IRD, Thesis Director
In summary: over the past 30 years, caesarean section rates have risen dramatically, with no obvious benefit to maternal and neonatal health. In the absence of effective interventions, C-section rates will continue to rise, particularly in low- and middle-income countries. The QUALI-DEC project aims to implement non-clinical interventions to reduce non-medically justified caesarean sections in four countries: Argentina, Burkina Faso, Thailand and Vietnam.
As part of this project, the aim of this thesis was to gain a better understanding of the non-clinical factors leading to increased caesarean section rates in the 32 hospitals participating in the project. We assessed the maternal and organizational factors influencing caesarean section use in a representative sample of women at low risk of caesarean section who had just given birth in the participating hospitals, using data from a cross-sectional survey. We used multilevel logistic regression models and propensity score matching analysis. Women’s preference for Caesarean section, which was low in our sample although varying from country to country, more frequent among nulliparous women and motivated by fear of pain and childbirth, favours recourse to Caesarean section. Factors linked to the organization of care, the availability of resources and hospital activity also influence the use of this procedure. Although identified in this research, these factors are not primarily responsible for the high caesarean section rates among low-risk women in hospitals. Other unmeasured factors, such as quality of care during labour and heterogeneity of clinical practice, are likely to be key determinants. There is an urgent need to ensure that the decision-making process is based, in this context, on women’s interests in view of the risks and benefits of each mode of delivery, their expectations and their clinical situation. To achieve this, it is necessary to improve women’s experience of childbirth, encourage their involvement in decision-making about the mode of delivery, and promote clinicians’ adherence to good practice.
Congratulations and good luck to Camille Etcheverry on her thesis, for her remarkable work over 3 years. We’d like to thank her for her commitment and for her scientific and human contribution to the QUALI-DEC project.
And for more information on QUALI-DEC: visit our website or download our application: https://www.qualidec.com/en/home-en/ or access our MOOC: mooc.qualidec.com
