Dear Editor,

After visiting several of my women friends and relatives who had delivered babies at hospitals and clinics, I noted that most of them - as well as other women patients -  delivered their first children by caesarean section in private clinics in Phnom Penh.

I have always wondered why there has been such an increase in caesarean sections during childbirth in recent years, especially in Phnom Penh. In order the achieve the Cambodian Millennium Development Goals, the government set a caesarean, or c-section, goal to be achieved

by 2015, which would see an increase of 4 percent in c-section procedures nationwide.

Such procedures were most likely to occur in Phnom Penh, with 4.6 percent of births in 2000 done by c-section compared to 7.2 percent in 2005, according to figures from Cambodia's Department of Health. When all the provinces are factored in, the percentage of c-section births was still 1 to 2 percent, generally because the mother had pre-existing medical conditions or experienced complications at the time of delivery.

But a few of my friends told me that private obstetricians have tried to frighten them into having c-section deliveries for inappropriate reasons, such as earning extra income for their own businesses, especially among mothers delivering their first child.

For example, if a woman delivers her child normally, she will pay about US$200 in medical expenses. For c-section deliveries, they pay $600.

Technically, a woman is only allowed a maximum of two c-section deliveries in order to prevent health risks. But private obstetricians cheat patients to boost their private practices rather than being professional. Unfortunately, it is hard for women who don't understand the specific details about c-sections nor how to complain to authorities when doctors try to cheat them through fear or misinformation.

It is unfair of obstetricians to take advantage of their patients' fears or lack of understanding. And we should not be satisfied merely with meeting the Millennium Goals through cheating. I believe that private clinics are taking advantage of a high maternal mortality rate to frighten prospective mothers.

The Ministry of Health should set conditions regarding when c-sections are appropriate and when they are not, and it should announce these conditions to all public and private clinics and monitor their performance so that all pregnant women have the information they need to deliver their babies safely and without fear.

Tong Soprach

Phnom Penh

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