Greece commits to addressing excessive reliance on caesarean sections

Greece has indicated its strong commitment to reduce the country’s rates of caesarean sections (C-sections) in line with the latest available evidence and good practices in the WHO European Region.

This intention was expressed during a WHO/Europe review organized to evaluate the situation, identify major driving factors for relying on C-sections, develop policy recommendations on the issue, and initiate a dialogue with the Greek Government, professional associations and other stakeholders to improve the situation.

Over half the births in the country occur by C-section, putting Greece among countries with the highest C-section rates in the world. C-sections can cause significant and sometimes permanent complications, disability or death, particularly in settings that lack facilities or capacity for safe surgery and for treating surgical complications. C-sections also have potential implications for newborns and subsequent pregnancies. Ideally, C-sections are only undertaken when medically necessary.

Dr Petr Velebil, Director of the WHO Collaborating Centre in Perinatal Health in Prague, Czechia, led the review on 7–11 November 2016. The review team met with legal experts, representatives from professional associations, academia, nongovernmental organizations protecting and promoting women’s rights, public and private providers of maternal and fetal care in Athens and Korinthos, and leaders of key departments involved in planning and financing maternal and fetal services in the Ministry of Health and the Organization for Health Care Services Provision (the national health insurance fund).

Stakeholders discussed the major driving factors of C-sections and potential solutions for mitigating them at a round-table meeting at the Ministry of Health on 7 November. Participants included representatives from all relevant professional associations: the Hellenic Maternal and Fetal Medicine Society, the Hellenic Midwives Association, the Hellenic Society of Obstetrics and Gynaecology and the Hellenic Society of Perinatal Medicine.

The review concluded with a wrap-up meeting of WHO experts and members of the Greek Ministry of Health on 11 November. The team presented their findings and participants discussed preliminary policy recommendations to reduce the rate of C-sections in Greece. They also reached an agreement on moving forward to seek consensus with stakeholders on the recommendations and their implementation.

The review was part of the Strengthening Capacity for Universal Coverage (SCUC) initiative, which supports Greece’s move towards universal health coverage.

Background on the SCUC initiative

The SCUC initiative is carried out with funding from the European Union through a grant agreement between the European Commission and WHO/Europe. Its objective is to contribute to improving health and health equity in Greece, especially among the country’s most vulnerable populations, by helping Greek authorities move towards universal health coverage and strengthen the effectiveness, efficiency and resilience of their health system.