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Caesarean Births Doubled Around the World Amid Signs of Both Overuse and Underuse

Allison Inserro
The number of infants born through caesarean section (C-section) almost doubled between 2000 and 2015—from 12% to 21% of all births—according to The Lancet. The surgery is still unavailable for many women in low-income countries and regions, yet is overused in many middle- and high-income settings, said the journal, which published a series of papers on the topic Thursday.
The number of infants born through caesarean section (C-section) almost doubled between 2000 and 2015—from 12% to 21% of all births—according to The Lancet. The surgery is still unavailable for many women giving birth in low-income countries and regions, yet is overused in many middle- and high-income settings, said the journal, which published a series of papers on the topic Thursday.

The research tracked trends in C-section use globally and in 9 regions based on data from 169 countries from World Health Organization and UNICEF databases.1

In the United States, the lowest use of C-sections was in New Mexico (nearly 18%); rates rose to 33.1% in New Jersey. Previous estimates for New Jersey c-section rates were 28%, according to data from the Leapfrog Group in 2015.

C-sections can be life-saving interventions for women and newborns when complications occur, such as bleeding, fetal distress, hypertensive disease, and infants in abnormal positions. But the surgery is associated with complications in future births and is not without risk.

It is estimated that 10% to 15% of births medically require a C-section due to such complications, implying that average C-section use would fall in the range.

However, the research found that:
  • Most countries used C-section above the recommended level (63%, 106/169 countries).
  • In 15 countries, C-section use exceeded 40%. The Dominican Republic had the highest rate, at 58.1%.
  • More than 1 in 4 countries in 2015 had levels below expectations (28%, 47/169 countries).
Within countries, large differences in use of C-sections exist between socioeconomic levels, between public and private sectors, and between regions, where the pace of change varied widely, with rapid increases seen in South Asia and much slower rises in Africa.

Disparities were found between low- and middle-income countries, where the wealthiest women were 6 times more likely to have a C-section compared with the poorest women, and where C-section was 1.6 times more common in private facilities than public facilities. Researchers suggested that this could be explained by persistent issues with shortages in health facilities and staff in vulnerable and rural populations.

However, the pace of change varied substantially between regions. In the 10 countries with the highest number of births in 2010 to 2015, there were large differences in C-section use between regions—for example, differences between provinces in China ranged from 4% to 62%, and interstate differences in India ranged from 7% to 49%.

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



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