Cutting through a global trend

Published online 26 October 2018

The numbers of babies born by caesarean section has doubled globally, calling into question the cause of this trend.

Sarah Elmeshad

BSIP/UIG via Getty Images
The number of babies born worldwide by caesarean section was almost 30 million (21 per cent) in 2015, nearly double that in 2000, according to a study published earlier this month in The Lancet, which analysed data from 169 countries.

Numbers were higher than the global average in some Arab countries. Caesarean section births in the Middle East and North Africa region rose from 19% in 2000 to almost 30% in 2015. According to the demographic and health survey, caesarean section births rose in Egypt from 11 to 55 per cent in 2015, while in Jordan they rose from 17.2 to 29.9 per cent.1  

Egyptian obstetrician Nevine Hassanein, who was not involved in the study, explained that rising numbers of caesarean sections conducted in Egyptian medical institutions could be due to increased case loads, junior doctors wanting to get more experience, or simply because some doctors don’t follow protocol.

The study found that caesarean section use was almost five times more frequent in the richest quintile in low- and middle-income countries compared to the poorest. It was also markedly high among more educated women, in countries such as Brazil and China, whose births were categorized as low-risk. Caesarean section use was also higher in private facilities than in public ones.

In some parts of the world, access to caesarean sections remained lower than needed based on medical need. The use of caesarean section in eastern and southern African countries, for example, was as low as 6% in 2015.

Rates were found to vary within countries from one region to another. In Ethiopia, for example, the national use of caesarean section was only two per cent, whereas in the capital, Addis Ababa, rates rose to 21.6%. 

Despite their invasiveness, caesarean sections can save lives. However, they are increasingly being resorted to for non-medical reasons, putting mother and baby at risk. According to the World Health Organization, the optimal rate for caesarean section births is between 10 to 15 per cent. 

Population health scientist Ties Boerma of the University of Manitoba, Winnipeg in Canada, the first author of the study, explains that the researchers did not find any clear association between caesarean section use and country income levels. However, wealthier women giving birth within the private sector could partially be behind rises seen at national levels.

“More work is needed to better understand why far more caesarean sections than necessary are being performed, what the role is of women’s agency in the demand for caesarean sections, the role of the system in providing and perhaps encouraging them, or even its role in discouraging caesarean sections when they are not necessary,” says Boerma.


Boerma, T. et al. Global epidemiology of use of and disparities in caesarean sections. The Lancet 392, 1341-1348 (2018).