title: Access to Cesarean Section Will Reduce Maternal Mortality in Low-Income Countries: A Mathematical Model.
abstract: BACKGROUND
  Despite global efforts to reduce the maternal mortality ratio (MMR) through the World Health Organization's (WHO) Millennium Development Goal 5 (MDG5), MMR remains unacceptably high in low-income countries (LICs). Maternal death and disability from hemorrhage, infection, and obstructed labor may be averted by timely cesarean section (CS). Most LICs have CS rates less than that recommended by the WHO. Without access to timely CS, it is unlikely that MMR in LICs will be further reduced. Our purpose was to measure the MMR gap between the current MMR in LICs and the MMR if LICs were to raise their CS rates to the WHO recommended levels (10-15 %).
  
  
  METHODS
  This model makes the assumption that increasing the CS rates to the recommended rates of 10-15 % will similarly decrease the MMR in these LICs. WHO health statistics were used to generate estimated MMRs for countries with CS rates between 10 and 15 % (N = 14). A weighted MMR average was determined for these countries. This MMR was subtracted from the MMR of each LIC to determine the MMR gap. The percent decrease in MMR due to increasing CS rate was calculated and averaged across the LICs.
  
  
  RESULTS
  We found an average 62.75 %, 95 %CI [56.38, 69.11 %] reduction in MMR when LICs increase their CS rates to WHO recommended levels (10-15 %).
  
  
  CONCLUSIONS
  Maternal mortality is unacceptably high in LICs. Increasing CS rates to WHO recommended rates will decrease the maternal mortality in these countries, significantly decreasing the mortality ratio toward the projected MDG5.
authors.affiliation: University of Tennessee Health Science Center College of Medicine, 910 Madison, Suite 1002, Memphis, TN, 38163, USA. sarahkellythomas@gmail.com.
authors.forename: Sarah
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Touro College of Osteopathic Medicine - New York, 230W 125th St #1, New York, NY, 10027, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Meadows
authors.affiliation: Vanderbilt University Medical Center, 1301 Medical Center Drive, MCE 3161C, Nashville, TN, 37232, USA.
authors.forename: K A Kelly
authors.initials: KA
authors.lastname: McQueen
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data*; D003906:Developing Countries; D005260:Female; D006801:Humans; D008428:Maternal Mortality; D008962:Models, Theoretical; D011247:Pregnancy