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Legislative Assembly for the ACT: 1997 Week 6 Hansard (19 June) . . Page.. 1822 ..

MR WHITECROSS: I have a supplementary question. Minister, do you concede that your claim that the employment decline had led to the patronage drop was nothing more than a convenient fiction invented by you to divert attention from the reduction in service standards presided over by your Government and defended by you personally - something which you have done nothing yet to address - and that you really cannot blame John Howard for the decline in service standards and patronage under this Government?

MR KAINE: Mr Speaker, it was a long question. There is a short answer: No.

MS TUCKER: My question is to the Minister for Health and Community Care, Mrs Carnell, and it relates to maternity services. Mrs Carnell, today in the paper it is reported that the ACT still has an unacceptably high rate of caesarean births. Despite the fact that the rate of caesarean births has dropped to about 16 per cent in the public sector, this is still much higher than the World Health Organisation's recommended 10 per cent rate and even higher than the 15 per cent recommended for underdeveloped countries. The rate in the private system is still very high - around 30 per cent, I understand. Has the ACT Government ever done a costing of what the high caesarean rates in the ACT cost the community, in terms of extra operations, extra care and the hidden longer-term costs for factors such as postnatal depression? Can the Minister also inform the Assembly of what the ACT Government is doing to ensure that we get down to the recommended World Health Organisation rate of 10 per cent across both the public and private sectors?

MRS CARNELL: Mr Speaker, the level of caesarean sections has been a very real issue for a very long time in the ACT. In fact, I can remember Mr Berry answering questions on the very same issue when he was Minister for Health. The issue is a very complex one. I am very pleased that the levels of caesarean sections in the ACT have started to fall in the public system, the system that we have some control over.

The issue of caesarean sections is much more complicated than it seems Ms Tucker is aware of. In the ACT, as Ms Tucker may or may not know, the average age of women producing babies is significantly higher than is the case generally in the world, according to the World Health Organisation figures. It probably is the case that we will never get down to the 10 per cent that is recommended by the World Health Organisation, as we have women in significantly higher age groups having babies in the ACT. As Ms Tucker may or may not be aware, the higher the age of women, particularly those having their first child, the higher the level of caesarean sections that occurs.

Mr Speaker, one of the things that we have to look at when considering the levels of caesarean sections in our hospital system is why women have caesarean sections and what the outcomes of those births are. One of the things that we should be enormously proud of in our public hospital system is the fact that the levels of maternal death and child death are very low - particularly maternal deaths. They are significantly lower, as I understand it, than is the case in the world. So you have to weigh up caesarean section rates with maternal death rates. You have to look at the outcomes that we are getting from our

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