ObjectiveTo generate a global reference for caesarean section (CS) rates at health facilities.DesignCross‐sectional study.SettingHealth facilities from 43 countries.Population/SampleThirty eight thousand three hundred and twenty‐four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing.MethodsWe hypothesised that mathematical models could determine the relationship between clinical‐obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three‐step approach to generate the global benchmark of CS rates at health facilities: creation of a multi‐country reference population, building mathematical models, and testing these models.Main outcome measuresArea under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate.ResultsAccording to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C‐Model, with summary estimates ranging from 0.832 to 0.844. The C‐Model was able to generate expected CS rates adjusted for the case‐mix of the obstetric population. We have also prepared an e‐calculator to facilitate use of C‐Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/).ConclusionsThis article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C‐Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS.Tweetable abstractThe C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems.

For ages, natural disasters, war and disease have been part of life, sharing themes of not only adversity, fear and death, but also hope. The year 2020 brought a new threat in the form of coronavirus disease 2019 (COVID-19), which challenged what humankind understood of all they knew and believed. The significant difference today is the role of the media in sharing news and opinions on this disease that threatens not only lives, but also spiritual well-being. In this study, we focus on people’s religious views on the origin and meaning of this invisible threat to establish how this pandemic impacts on people’s belief systems. The 20th century was marked by a shift whereby actions and events are intellectualised to rationalise cause and effect, and the philosophical theodicies are regarded to limit our critical reasoning. This study, however, shows that COVID-19 reactivates this debate in that it surpasses logic and rational thinking. Data are collected by means of comments, discussions and opinions shared on numerous social media platforms. During times of adversity, the same rhetorical ‘who’ and ‘why’ questions are asked and in this regard, theodicy as a philosophical framework informs this study. Applying a narrative inquiry, data are interpreted and three themes are identified, namely COVID-19 is an act God, COVID-19 has nothing to do with God and God remains in control amidst a devastating pandemic. The sample for this study is random and the medium used allows for representativity in terms of age group (18+), gender, race, religious affiliation of South Africa, but not limited to this country.Contribution: This article provides insight into renewed debates on religious views on pandemics and suffering in the context of COVID-19. It contributes to an understanding of different perceptions on the origin of this disease, how people make sense and find meaning in being part of a global discourse.

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