High Mortality Cesarean Delivery Rate & Teen Pregnancy in Aruba

How we care for our children and the children who have children tell a lot about a society. Who is looking out for the most vulnerable among us? In Aruba, the numbers from a report done on teen pregnancy and infant mortality rates were staggering. Children are supposed to be our greatest treasure, aren’t they?

The enormous amount of cesareans – the Aruban percentage is one of thee highest in the world – and the many teen pregnancy, are the possible cause of the high number of babies that die during pregnancy or right after birth.  The mortality figure is at the same level as that of the South-American countries.

The percentage of babies that die during pregnancy (22 weeks or more) or right after delivery (7 days after birth) – in the medical world defined as prenatal death – is with 18.1 permillage more or less the same level as that of South-American countries (19 permillage).  That is very high, compared with the Netherlands (8 permillage).

High mortality of caesarian deliveries and teen pregnancy (Amigoe: June 9, 2008)

Aruba does not have an intensive-care for seriously ill newborns.  They are sent abroad via air-ambulance for treatment.

ORANJESTAD – The enormous amount of caesarians – the Aruban percentage is one of thee highest in the world – and the many teen pregnancy, are the possible cause of the high number of babies that die during pregnancy or right after birth.  The mortality figure is at the same level as that of the South-American countries.

These are some striking conclusions from the inquiry into the prenatal care on our island in the period of 2005 – 2007 conducted by Esther Klopper and Caroline Nierkens, two medical students of the Radboud University Nijmegen in the Netherlands.  In anticipation of a report that is currently being finished, the two students gave a closed presentation in the Horacio Oduber Hospital (HOH). 

It was sheer drudgery, said medical director Arnoud Boesten.  He is very impressed wih the work of the students.  He thinks that a continuing inquiry is necessary.  It was indeed not easy for the two; the figures were very difficult to get or they didn’t match those of institutions like the Central Bureau of Statistics (CBS).

The percentage of babies that die during pregnancy (22 weeks or more) or right after delivery (7 days after birth) – in the medical world defined as prenatal death – is with 18.1 permillage more or less the same level as that of South-American countries (19 permillage).  That is very high, compared with the Netherlands (8 permillage).  Also the number of stillborns is high; 11.4 permillage versus 5 permillage in the Netherlands.  The figure is almost as that if Central America.  The neonatal death (babies that die in the first 28 days after birth) is 8.1 permillage and is at the same level as East-Europe (South-America 14 permillage and the Netherlands 4).  It appears that of the total number of newborns that died  within 28 days after birth (32) and stillborns after 24 weeks of pregnancy (36), 50 died in the HOH; 11 babies after still in the womb of the mother were flown abroad for treatment and 7 after already born in HOH and flown abroad for treatment.  

The figure that caused most commotion in the room was the very high number of caesarians – almost one of the highest in the world.  Besides, this confirms the figures of White-Yellow Cross in January of this year.  Of the 1418 deliveries between 2005 and 2007, 471 (34 percent) were by caesarian.  Compared to Europe, Aruba is the frontrunner and after Chili, also in South-America.

The percentage of caesarians according to the World Health Organization is considered acceptable in most of the developed countries is about 15 percent.

The inquiry does not reveal that the extreme high number of caesarians is the cause of the high number of babies that die during pregnancy or right after birth.  The students say that it might be.  It is known that babies born by caesarian have a bigger chance of getting sick or die.  A caesarian is also riskier for the mother than a natural delivery.

TEEN PREGNANCY

The inquiry also doesn’t directly connect the high prenatal death with the high number of teen pregnancy (12.1 percent).  That may also be one of the causes, according to the students; besides, the younger the mother, the bigger chance on complications during pregnancy and birth and premature babies.  Compared with the Netherlands (1.1 percent) and even the Neth.Antilles (9 percent), the number of teen pregnancy in our country (12.1) is considerably higher.  The students base this on figures of the CBS, but the figures from their inquiry are even higher, 12.6 percent, which doesn’t include deliveries at home.  The figures of CBS do include home deliveries.

The Figures of the Netherlands and Neth.Antilles are from 2004 till 2006 inclusive; but they do show a striking difference; also in the age categories after 2006.  Aruba has a higher percentage of young mothers; age 20-24, 24.5 percent and 25-29, 26.1 percent.  The two students and their councilor at HOH, pediatrician Wicha Ponson-Wever, are clearly very worried about this.  In their eyes, the subject needs more society and government attention.  The students say that the enormous number of caesarians may be reduced considerably; even due to the enormous costs that are involved.  Other factors that also play a part in the prenatal death in Aruba are the multi-cultural population, the multiple appearance of overweight among pregnant women, and the obstetrical care that can be better, according to the students.

TRANSPORTATION

The objective of Klopper en Nierkens’ inquiry was mainly to get in idea of the sick- and death figures among the transported newborns.   They also wanted to see whether there are problems with the transportation of the patients and the course of the care.  Our island does not have an intensive-care ward for newborns, and because of this, newborns that are seriously ill, must be transported abroad for treatment via air-ambulance.  This transport can often be done already before birth (intra-uterien), or also after birth (neonatal).  Almost all the transports go to Colombia – paid by AZV – that has a special centre (prenatal centre) to treat these patients.