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Use of caesarean section almost doubles since 2000

21% of births globally are C-section, study shows

Adrian O'Dowd

Friday, 12 October 2018

Numbers of children born through caesarean section (C-section) almost doubled between 2000 and 2015 from 12% of all births to 21%, according to a series of three papers1,2,3 published today in The Lancet.

Researchers found that although the life-saving surgery was still unavailable for many women and children in low-income countries and regions, the procedure was overused in many middle and high-income settings.

Although C-section is a life-saving intervention for women and newborns when complications occur such as bleeding, foetal distress, hypertensive disease, and babies in abnormal position, the surgery still carries risk for mother and child, and is associated with complications in future births.

Currently, it is estimated that 10-15% of births medically require a C-section due to complications, suggesting that average C-section use should lie between these levels.

For the Lancet series, an international team of researchers tracked trends in C-section use globally and in nine regions based on data from 169 countries from WHO and UNICEF databases.

Globally, C-section use has increased by 3.7% each year between 2000-2015 – rising from 12% of live births (16 million of 131.9 million) in 2000, to 21% of live births (29.7 million of 140.6 million) in 2015.

However, the pace of change varied substantially between regions. The South Asia region has seen the most rapid increase in use (6.1% per year), with C-section being underused in 2000 but overused by 2015 (increasing from 7.2% of births via C-section to 18.1%).

In contrast, improvements have been slow across sub-Saharan Africa (around 2% per year), where C-section use has remained low (increasing from 3% to 4.1% of births in West and Central Africa, and from 4.6% to 6.2% in Eastern and Southern Africa.

Analysis of data showed that more than one in four countries in 2015 had lower levels (28%), while most countries used C-section above the recommended level – 63%.

In at least 15 countries, C-section use exceeded 40% and the five countries with the highest use were the Dominican Republic (58.1%), Brazil (55.5%), Egypt (55.5%), Turkey (53.1%), and Venezuela (Bolivarian Republic of) (52.4%).

Globally, 60% of countries overuse C-sections, and 25% underuse the procedure.

C-section continued to be overused in North America, Western Europe and Latin America and the Caribbean.

In the UK, C-section use has increased from 19.7% of births in 2000 to 26.2% in 2015.

C-section use also increased from 24.3% to 32% between 2000-2015 in North America, from 19.6% to 26.9% in Western Europe, and from 32.3% to 44.3% in Latin America and the Caribbean.

The authors found that the global increases in C-section use were due both to more births taking place in health institutions and to greater frequency of intervention through C-section in health facilities.

Series lead Dr Marleen Temmerman from Aga Khan University, Kenya and Ghent University, Belgium, said: “The large increases in C-section use – mostly in richer settings for non-medical purposes – are concerning because of the associated risks for women and children.

“C-sections can create complications and side effects for mothers and babies, and we call on healthcare professionals, hospitals, funders, women and families to only intervene in this way when it is medically required.”

Fellow series author Professor Jane Sandall of King’s College London, said: “C-section is a type of major surgery, which carries risks that require careful consideration. The growing use of C-sections for non-medical purposes could be introducing avoidable complications, and we advocate that C-section should only be used when it is medically required.”


  1. Temmerman M et al. Global epidemiology of use of and disparities in caesarean sections. Lancet 2018; 392: 1341–48.
  2. Sandall J et al. Short-term and long-term effects of caesarean section on the health of women and children. Lancet 2018; 392: 1349–57.
  3. Betrán A P et al. Interventions to reduce unnecessary caesarean sections in healthy women and babies. Lancet 2018; 392: 1358–68.

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