The rising rate of caesarean sections in Cyprus has sparked significant debate among healthcare professionals.
Concerns Over HIO Policy
Dr Pantinos Mavrogenis, a prominent member of the Gynaecological Society of Cyprus, has voiced strong objections to the Health Insurance Organisation’s (HIO) proposed financial penalties aimed at reducing the number of non-emergency caesarean sections. He labels this initiative as both “unscientific” and “ethically questionable,” warning that it could jeopardise the health of mothers and their babies.
In an interview, Dr Mavrogenis emphasised that empowering women means enabling them to participate meaningfully in childbirth decisions rather than imposing external pressures. “The right information and tools must be provided so that women can make informed choices based on professional medical advice,” he asserted.
The HIO’s New Framework
As part of its strategy to address the notably high rates of caesarean sections in Cyprus—currently among the highest in the European Union—the HIO plans to implement a rewards-and-penalties system for gynaecologists by early 2026. Under this new framework, doctors who maintain a caesarean section rate below 30% will be rewarded with bonuses, potentially increasing their childbirth-related income by up to 15%. Conversely, those exceeding the set thresholds will face steep financial penalties.
For instance, a gynaecologist with a non-emergency caesarean section rate between 30% and 40% will see their bonus diminish to 5%, while those with rates between 40% and 50% receive no bonuses at all. Rates exceeding 50% will lead to deductions ranging from 5% to 35%, affecting a significant portion of their earnings. In one example, a doctor delivering 159 births, of which 85 are non-emergency caesareans, would face a penalty that reduces their income by €7,500.
Although these penalties aim to promote normal deliveries, gynaecologists argue that this simplistic approach does not account for the complex realities of modern childbirth. Many women in Cyprus, particularly those over 40 and those who have undergone IVF treatments, often face higher risks that can necessitate planned caesarean sections.
Understanding the Bigger Picture
Dr Mavrogenis points out that contemporary lifestyle changes have resulted in higher birth weights among newborns, alongside a trend of women having narrower pelvises, factors that can complicate vaginal deliveries. “A caesarean at the mother’s request can still be medically indicated. Denying this choice can undermine trust in the patient-doctor relationship,” he remarked.
Legal concerns also arise, particularly regarding malpractice claims. According to Dr Mavrogenis, complications during natural births tend to lead to more lawsuits than those involving caesarean deliveries. As a result, the pressure to adhere to quotas may compel doctors to make unsafe decisions rather than focus on individual patient needs.
Data from the health ministry reveals that between 2021 and 2023, Cyprus has seen caesarean rates exceeding 60%, with only 15% to 17% deemed medically necessary. This alarming statistic highlights the urgency of the situation and raises questions about how best to address it.
A Call for Education, Not Penalties
While the government acknowledges the pressing need to tackle rising caesarean rates, critics like Dr Mavrogenis argue that financial penalties are not an effective solution. “The answer lies in education,” he explained. Both healthcare professionals and expectant mothers need to be better informed about the risks and benefits involved in childbirth.
By equipping women with knowledge, they can make empowered decisions about their birthing plans. “True patient-centred medicine requires that we support women in understanding their options. This should be our priority,” Dr Mavrogenis contended.
In conclusion, as Cyprus navigates the complexities of childbirth practices within its healthcare system, a balanced approach that combines education with patient autonomy may offer the best path forward. By fostering open communication between healthcare providers and patients, Cyprus can aspire to lower caesarean rates while ensuring the safety and well-being of mothers and babies alike.
