Global epidemiology of use of and disparities in caesarean sections

Abstract

This Lancet Series paper, one of three on the high rate of Caesarean Section (CS), describes the global, regional and selected country levels, trends, determinants and inequalities in CS. Based on data from 169 countries representing 98.4% of the world's births, we estimate that 21.1% (95% uncertainty range 19.9-22.4%) or 29.7 million births occurred through CS in 2015, representing almost a doubling since 2000 (12.1%; 10.9-13.3%). The differences in CS rates between regions in 2015 were tenfold, with a high of 44.3% (41.3-47.4%) in the Latin America and the Caribbean region and a low of 4.1% (3.6-4.6%) in the West and Central African region. The global and regional increases were driven both by increasing coverage of births by health facilities (66.5% of the global increase) and higher CS rates within health facilities (33.5%), with considerable variation between regions. Based on the most recent data, population-based CS rates exceeded 15% of births in 63% of 169 countries, while 28% countries had CS rates below 10%. National CS rates varied from 0.6% in South Sudan to 58.1% in the Dominican Republic. Within-country disparities in CS rates were also very large, with a sixfold difference in CS rates between births in the richest and poorest quintiles in low-and middle-income countries, markedly high CS rates among low obstetric risk births among especially more educated women in Brazil and China and 1.6 times higher CS rates in private facilities compared to public facilities.

Neonatal weight loss and gain patterns in caesarean section born infants: integrative systematic review

“…A prospective cohort of 788 exclusively breastfed mother-baby dyads were recruited in Majorca, Spain to examine breastfeeding (Boerma et al, 2018). As such, it is important to understand the potential impact of CS on women and their infants in the immediate and longer term post-natal period and to update guidelines and content and planning of post-natal care accordingly.…”

Alarming global rise in caesarean births, figures show

“…A series of three papers published in the Lancet shows that 106 out of 169 countries have caesarean section rates above the 10% to 15% of births that is thought to be optimal 123. In at least 15 countries the caesarean rate exceeds 40%, including the Dominican Republic (58.1%), Brazil (55.5%), Egypt (55.5%), and Turkey (53.1%).…”

OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section

“…6 Ulster University, Jordanstown, Belfast, Northern Ireland, UK. 7 Department of Public Health, Interuniversity Centre for Health Economics Research (I-CHER), Vrije Universiteit Brussel, Brussels, Belgium. 8 Association for Improvements in the Maternity Services, Surrey, UK.…”

“…A recent systematic review by the World Health Organization shows that 106 out of 169 countries have CS rates greater than the 9 to 16% level above which no decrease in maternal or neonatal mortality is seen [6]. CS rates exceed 40% in some countries, including the Dominican Republic (59%), Brazil (56%), Egypt (63%), and Turkey (53.1%) [7]. Given the short and long-term adverse effects of CS, these rates cause concern [8].…”