From 2000 to 2015, the number of infants born via cesarean delivery increased from 12% to 21%, according to a 3-paper series study published in The Lancet1 and presented at the International Federation of Gynecology and Obstetrics (FIGO) World Congress in Brazil.

An estimated 10% to 15% of all births require cesarean delivery due to pregnancy complications. However, the majority of countries report rates of cesarean delivery above these levels. According to lead author Marleen Temmerman, PhD, from Aga Khan University, Kenya, and Ghent University, Belgium, “…The large increases in [cesarean delivery] – mostly in richer settings for non-medical purposes – are concerning because of the associated risks for women and children. [Cesarean deliveries] 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.”2

Data from 169 countries were obtained to identify global disparities in cesarean delivery rates; results indicate that between 2000 and 2015, the use of cesarean delivery increased by 3.7% each year. Increased rates of cesarean delivery were attributed primarily to more births occurring in a healthcare setting, as well as increased frequency of cesarean delivery in these settings.2

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The researchers identified economic disparities as a driver for the differences in cesarean delivery rates globally; wealthier women and those using a private healthcare institution were more likely to undergo cesarean delivery compared with poor women and those using a public facility.2

The investigators cautioned against the use of cesarean delivery in the absence of a medical indication and outlined the risks associated with C-section, including maternal death and disability, as well as scarring that can cause bleeding, abnormal development of the placenta, and in future pregnancies ectopic pregnancy, stillbirth, and preterm birth. Infants born via cesarean delivery may also experience hormonal, physical, bacterial, and medical exposures that can affect their health, including changes in their immune system that have the potential to increase the risk of allergies and asthma.2

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“Although there is almost universal consensus that [cesarean delivery] use has increased beyond the reasonable level of need in many countries, effective interventions to optimise use have proven elusive. Interventions should recognise previous birth experiences, consider the health effects of [cesarean delivery], and provide emotional support,” stated Ana Pilar Betran of the World Health Organization. “Interventions should provide a sense of empowerment for women, and will require meaningful conversations with health professionals, policymakers and advocacy groups to influence the discussion around maternity care.”2


  1. Boerma T, Ronsmans C, Melesse DY, et al. Global epidemiology of use of and disparities in cesarean sections. Lancet. 2018;392(10155):1341-1348.
  2. Caesarean section use has almost doubled globally since 2000 [news release]. London, UK: Lancet. October 11, 2018. Accessed October 34, 2018.