Kenyan insurers shaken by C-section delivery rise

Numerous interviews with medical insurers, including Jubilee, AAR Insurance, and Britam, have shown that Caesarean section deliveries, also known as C-sections, are responsible for about 70% of their maternity-related costs.
For instance, 67%, or Ksh1.11 billion, of the Ksh1.67 billion Jubilee Health, one of the biggest health insurers in Kenya, paid for deliveries in the previous five years went toward Caesarean sections.
Jubilee has seen a rise in the percentage of C-sections in the total deliveries that used its medical card over this time, from 42% to 58%.
While insurers are worried about this trend, they are frequently cautious not to appear to be interfering with women’s perceptions that C-section deliveries are less risky than regular deliveries or indicative of a lower social status.
“While there are situations where a C-section is necessary, many women today claim they are too posh to push. Therefore, normal birth is essentially seen as something for the underprivileged or for people without health insurance,” according to Njeri Jomo, CEO of Jubilee Health Insurance.
“One is virtually perceived as carrying an open check when they arrive at the hospital carrying a medical card. Our costs will be painful depending on how much this affects whether the delivery will be a C-Section or routine.”
According to the most recent statistics from Kenya’s National Bureau of Statistics (KNBS), the percentage of deliveries by C-section has nearly doubled over the past eight years, rising from 9% in 2014 to 17% in 2022.
Kenya had 1.24 million hospital deliveries last year, of which 211,227 were C-sections, up from 110,900 in 2014, when there were 895,400 hospital deliveries overall.
Last year, C-sections cost more over Ksh210,000 at hospitals including M.P. Shah, Aga Khan, Nairobi, and Mater, with emergency C-sections costing more than Ksh300,000.
In the same facilities, standard deliveries cost between Ksh80,000 and Ksh100,000. The price increases have been in line with inflation.
According to a 2018 advice note from the World Health Organization (WHO), the “sustained and unprecedented rise in caesarean section rates is a major public health concern.”
According to the WHO, the optimal C-section rate should be between 10% and 15%, and superfluous procedures have no demonstrable benefits.
Additionally, it had come to the conclusion in 2015 that C-section rates greater than 10% did not correlate with lower rates of maternal and neonatal mortality.
According to the WHO, “There is no evidence demonstrating the benefits of caesarean delivery for women or infants who do not require the procedure.”
According to KNBS data, in Kenya, the percentage of C-section deliveries is twice as high in urban regions (23.8%) as it is in rural areas (12.3%).
The percentage of live newborns delivered by caesarean section at hospitals run by religious organizations and the private medical sector (as opposed to those run by non-governmental organizations) was 28.2% and 27.8%, respectively.
This is almost twice as much as the 15% in hospitals serving the public sector.
According to Dr. Patrick Gatonga, the CEO of AAR Insurance Group, between 15 and 20% of the inpatient cases involving women covered by AAR medical coverage are related to pregnancy, and as a result, more C-section deliveries have resulted in greater claims.
“The economic impact is significant if you take into account the price discrepancy, where fees for C-sections are occasionally twice as much as fees for regular deliveries. According to Dr. Gatonga, it is one of the major expense factors for health insurance claims.
“C-section poses an outcome impact because, if performed improperly, complications, including long-term ones, are not uncommon and ultimately raise the cost of healthcare coverage.”
In comparison to 2014, when only five counties—Kirinyaga, Embu, Tharaka-Nithi, Kiambu, and Nairobi—had the share of C-Section deliveries exceeding 15% of total deliveries, caesarean section deliveries are currently greater than the anticipated upper limit of 15% in 19 counties.
The rate of cesarean deliveries is 40% in Kirinyaga, followed by 33% in Kiambu, 30% in Tharaka-Nithi, 28% in Nairobi, and 27% in Taita/Taveta.
The counties with the lowest percentages of cesarean section births are Samburu (5%), Mandera (4%), and Wajir (2% each).
According to Jackson Theuri, chief executive of Britam General Insurance, “the supply-induced demand of C-sections has had a negative impact on the profitability of medical insurance, primarily because of the increased cost of care and premium loading in effect to this utilization.”
According to the KNBS poll, compared to 14% of women who had normal deliveries, 84% of women who underwent caesarean sections spent three days or more in a medical facility.
Generally speaking, a prolonged hospital stay results in even higher medical costs.
According to Nizar Juma, chairman of Jubilee Insurance, behind these bundles of joy delivered via C-section has been the anguish of insurers and physicians who say that they are merely prioritizing the lives of their patients.
“We can mostly attribute it to physicians convincing their patients to get a C-section since they can earn up to four times as much money. Every word a doctor says to a patient is like God speaking,” according to Mr. Juma.
“Doctors are advising their patients that they have control over the day and time of delivery, won’t experience any discomfort, and can select the birthdate of their choice. They may not be informed of any potential concerns associated with C-sections, in my opinion.”
C-sections may be necessary in cases of protracted or obstructed labor, distress in the fetus, or when the infant is born in an unusual position.
Despite all of its benefits, policymakers like the WHO claim that it also has both short- and long-term hazards.
In 2020, researchers from Moi University School of Medicine presented the findings of a study that shown “substantial” overuse of C-sections based on hospital rules, with more than 40% of primary C-sections missing adequate documentation.
The records of 12,209 women who gave birth at the Moi Teaching and Referral Hospital in 2014 were examined by gynecologist Hillary Mabeya and his associates. The International Journal for Equity in Health published their study.
The study’s conclusion said that “our study demonstrates that unnecessary primary C-sections and nearly universal repeat C-sections play a significant role in explaining both the overall C-section rate and socio-economic inequalities in C-sections.”
“Our study suggests that promoting safe trial of labor with close monitoring in women with a scarred uterus and preventing unnecessary primary C-sections could help reduce the C-section epidemic.”
According to official data, the likelihood of a C-section rises with the mother’s age, education level, number of prenatal visits, and socioeconomic status.
Compared to 5% of births for women in the lowest wealth quintile, caesarean sections were used to deliver almost 33% of live births for women in the highest wealth quintile.
Ms. Jomo’s assertion that social status and medical coverage have a significant impact on the manner of birth is supported by the fact that women who are poor, have little to no education, and live in rural regions experience lower rates of C-sections.
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