The rate of births by caesarian section is used as a health service coverage indicator. It reflects the accessibility of basic health interventions to a given population. It is computed by dividing the number of caesarian section deliveries by the total number of live births.
The most common indications for caesarian section include fetal distress, malpresentation, failure to progress in labor, and previous caesarian section. Worldwide, the average number of CS deliveries is at 16%. In low income countries, the average is at 6%, while those in upper middle and high income countries are at 30%. The African Region has the lowest rates at 4%, while the WHO Region of the Americas has the highest rates at 36%. Countries like Ethiopia, Chad, Madagascar and Mali have CS rates of 2%. The United States, Australia and Germany have CS rates of 32%.
Both underuse and overuse of CS delivery can be dangerous, but the ideal rate for CS deliveries has not been set. The World Health Organization has advised that CS rates should be between 5-15%, but at present, there is no empirical evidence to set the optimum rates of CS deliveries.
The wide differences in number of CS births between high income and low income countries reflect the disparity in access to health care services. Low CS rates indicate unmet obstetric needs while high rates suggest inappropriate use. In low income countries with lower than recommended CS rates, maternal death during childbirth remains one of the leading causes of mortality among women of reproductive age.
On the other hand, excessive or unnecessary CS deliveries are also linked to maternal and infant risks. There are many contributing factors to the increasing trends of CS rates in high income countries. There is an increasing number of CS deliveries upon maternal request. It is higher in women who have private medical insurance and those who have higher income and levels of education. Other factors include legal concerns, with increasing fear of litigation among health practitioners. Advancing maternal age and increased obesity rates are also contributing factors.
1) World Health Organization. World Health Statistics 2013. http://www.who.int/gho/publications/worldhealthstatistics/ENWHS2013Full.pdf
2) World Health Organization. Monitoring emergency obstetric care: a handbook. 2009. http://www.unfpa.org/webdav/site/global/shared/documents/publications/2009/obstetric_monitoring.pdf
3) World Health Organization. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage. 2010. http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf