, Volume 13, Issue 3, pp 494-499
Date: 24 Jun 2010

Fertility After Cesarean Delivery Among Somali-Born Women Resident in the USA

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We evaluated the reproductive impact of cesarean versus vaginal delivery in Somali immigrants. Data were extracted for 106 Somali women delivering vaginally (64%) or by cesarean section (36%) between 1994 and 2006. Index delivery (vaginal versus cesarean) was compared to the cumulative incidence rate of subsequent deliveries. The incidence rate of a delivery after a vaginal delivery was 3.3% (CI:0–7.8%), 55.4% (CI:40.1–66.8%) and 74.4% (CI:59.0–84.0%) at 1, 2 and 3 years. Cesarean delivery lead to a second delivery incidence rate of 2.9%(95%CI:0–8.2%), 25.9%(95%CI:9.8–39.2%) and 58.1% (95%CI:27.0–72.2%) at 1, 2 and 3 years. Somali women delivering vaginally were 1.56 times (95% CI:0.94–2.57; P = 0.084) more likely to have a subsequent delivery. The likelihood of Somali women having a second child after cesarean section is lower at 2 and 3 year follow-up.

New contribution to the literature

We are submitting this manuscript to bring attention to the fertility implications of the high cesarean section rates among Somali born refugee women. A paper written by Small et al. recently published in the BJOG demonstrates that Somali women are experiencing cesarean section rates higher than those in their receiving countries. Our findings indicate that the women who undergo cesarean sections are less likely to have children within 2 years after their delivery than the group who delivers vaginally. This decrease in fertility at 2 years is especially concerning given the importance and predominance of large families in the Somali culture. Women have on average 5.2 live births during their lifetime. We believe that the high cesarean rate in conjunction with the decrease fertility at 2 years presents a significant finding that should be considered and shared with Somali patients during their pregnancy. Consequently, building trust and cultural competency through well guided counselling that addresses the concerns of Somali women is of vital importance in easing their transition to a new health care system and a new country.