I wish to inform the House that statistics show that there has been an increase in the percentage of c-section carried out in both public and private health institutions from 46.3% in 2015 to 61.4% in 2024. I am also informed that the age 20 to 34 years have recourse to c-section, and it is following the same trend during the last five years. With regard to part (a) of the question, according to latest figures of 2024, out of 8,052 total births in public hospitals, the ratio of normal delivery to c-section is almost one to one (1:1) whereas in private health institutions, for 2024, out 4,103 total births, the ratio of normal delivery to c-section is one to two (1:2). Madam Speaker, with regard to part (b) of the question, in line with World Health Organisation’s recommendations, my Ministry is implementing several measures to reduce the need to carry out c-section deliveries, amongst others – (i) Pre-conception care and counselling is conducted regularly by Community Health Care Officers in the community; (ii) Women are encouraged to plan and space their pregnancies through the use of contraceptives provided free of charge in family planning clinics; (iii) Antenatal care is provided as early as possible in primary health centres and include one to one and group counselling, echography’s and vitamins and iron supplementation; (iv) High risk cases and teenage pregnancies are referred to regional hospitals for specialised follow-up by obstetricians; (v) Labour wards are fully equipped to ensure cardiotocographic monitoring of labour and foetal heart rate to prevent complication during labour; (vi) Decisions to conduct a caesarean section are based on clear indication;

88 (vii) Other measures include capacity building of health professionals involved in maternal and child health based on updated on national obstetrics protocols. Madam Speaker, through these measures the Ministry remains committed to ensuring that every caesarean section is performed for the right reasons, at the right time and in the right setting, thereby aligning national practices with international best standards. Caesarean section is absolutely critical to save lives in situation where deliveries would pose a risk such as malformation of foetus, hypertension in pregnancy, maternal complication, gestational diabetes mellitus, foetal distress or due to baby’s malpresentations. According to new research from World Health Organisation, birth by caesarean section continue to rise globally, now accounting to more than one in five, that is, 21% of all child births. This number is set to continue increasing over the coming decade with nearly a third or 29% of all births likely to take place by caesarean section by 2030. Mauritius is also following the same international trend regarding the increase in caesarean section deliveries. There are so many other reasons accounting for the increased number of caesarean section deliveries. To name a few – (i) Increasing maternal age and numbers of multiple births; (ii) Higher rates of obesity among women; (iii) A lot of previous caesareans pregnant ladies required to be sectioned, and (iv) Increased number of sexually transmitted diseases. My Ministry is also proposing to take the following additional measures to address the issue of increasing caesarean rate – (i) Clinical audit and monitoring to assess whether indications are being undertaken in public hospitals to ensure medical justification and adherence to WHO guidelines; (ii) Updating and standardising national protocol to emphasise evidence-based management of labour and delivery, including use of WHO Robson classification system, to monitor and compare CS rates between facilities;

89 (iii) Organisation of continuous medical education and refresher courses for obstetricians, midwives and labour ward staff to strengthen decision-making during labour management and promote safe, normal deliveries where feasible; (iv) Strengthen antenatal counselling on normal delivery, and (v) Public education campaigns to highlight that vaginal delivery remains the safest options where no medical contradictions exist.

Yes!

Thank you, Madam Speaker. Can the hon. Minister inform the House whether any study has been carried out on how Mauritius is affected as compared to other countries in the SADC region? Thank you.

Madam Speaker, I do not have any information regarding such type of studies which have carried out. Of course, as I have already mentioned, this is the international trend. I do hope that with the measures that we have taken, we can put – I do not say an end –, but rather a break to this system which is, in fact, not normal.

Thank you, Madam Speaker. My second question is: why is it that the cost of CS in public institutions is less than those performed by private institutions? Has this also been looked into, hon. Minister?

Sorry, I missed the last part. Are you saying there are more in public hospitals?

No.

No. It is the contrary?

Yes.

But it is still a lot? Yes!

If you compare public hospitals with private hospitals, you find in public hospitals, it is less. The number of caesareans is less than in private hospitals. Probably, all prosperous people go in private hospitals.

So, it is a question of money?

Maybe they want to get the best way out. That may be one of the reasons.

Do not say that, hon. Minister! The best way out? Do not say that!

90

I am not an expert in that field, but I mean to say, I get the feeling that they want the easiest way instead of going through pain and all.

On appelle ça la facilité. Let us finish.

My last question. Thank you, Madam Speaker. Can the hon. Minister provide us some statistics? Thank you.

Of course, I am going to provide the detailed statistics.

Please lay it on the Table.

I will lay it on the Table.

It is such an important issue, and you know that it is dear to my heart. Yes, hon. Dr. Prayag!

Thank you, Madam Speaker. Thank you, hon. Minister. While providing the statistics, I think it would be more informative if we could have been provided the statistics of elective normal deliveries and elective caesarean section as compared to public and private institutions. Separately, the comparison of emergency vaginal deliveries and c- sections in public and private institutions. Then, we might be able to really compare how many insurance companies come into the game here.

I know you are interested in the subject. I am going to provide you a bulky document on this. All the details will be provided. I will take some time.

Thank you so much, hon. Minister. Yes!

Thank you, Madam Speaker. May I ask the hon. Minister if he has the information or the statistics about caesarean sections prevalence in Rodrigues? What is the actual situation thereat, if any?

Surement, c’est plus naturel là-bas.

Madam Speaker, I expected a question from Rodrigues. For the period of 2020-2025, the last five years, out of 4,929 births in Rodrigues, 1,938 babies were delivered by CS which corresponds to most 39.3% of the overall births.

91 Statistics indicate that over the past 5 years, there is an increase in the number of CS performed. In 2020, it was 38.1%. Now, it is 43.3% for 2025. So, even Rodrigues needs some special attention.

En français, on dit la naissance par le bas. On a appris cela récemment. It seems that seems that I have more questions that have been withdrawn: B/1165 and B/1168. Now, time is over! Thank you very much, hon. Minister and everybody.