Study: Cesarean Births Nearly Doubled Globally Since 2000

The percentage of women giving birth by cesarean section has increased dramatically this century, almost doubling globally since 2000, as the surgical procedure is increasingly overused in some countries, new data show.

Around the world, 21 percent of births in 2015 were delivered by cesarean or C-section, according to a collection of new studies organized for the International Federation of Gynecology and Obstetrics World Congress in Brazil, and published Thursday in The Lancet. That number is up from 12 percent in 2000.

Almost two-thirds of all countries overuse the procedure while a quarter underuse it, highlighting a sharp disparity in the extent to which medical facilities adhere to established recommendations for employing C-sections, as well as disparities in access to proper care.

Medical professionals estimate that between 10 percent and 15 percent of births require the surgery, which can be life-saving, so global rates should in theory match that number. C-sections are traditionally reserved for circumstances that include prolonged labor, placenta abnormalities, cord prolapse, distress of the fetus, certain diseases and if the baby is in an abnormal position.

However women in some parts of the world increasingly request C-sections for other reasons, including prior negative experiences with natural births, a fear of labor pain or damage to their bodies, or concerns about future sexual function. The study says there are no benefits of employing the procedure without a medical reason and indeed women and babies can die from complications from C-sections when a medical facility is under-resourced and staff are under-trained.

The rise is also due both to an increase in births as as the global population grows, and access to medical facilities, the studies say. Doctors are increasingly recommending C-sections, and the studies’ authors warn that young physicians are losing confidence in their ability to assist in vaginal births.

“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,” Dr. Marleen Temmerman with Aga Khan University in Kenya and Ghent University in Belgium said in a statement. “In cases where complications do occur, C-sections save lives, and we must increase accessibility in poorer regions, making C-sections universally available, but we should not overuse them.”

The use of C-sections is highest in the Dominican Republic, Brazil, Egypt, Turkey and Venezuela, accounting for more than half of all births there. Rates have increased the most sharply in South Asia, where C-sections accounted for 7 percent of births in 2000 — an underused rate — but have since risen to more than 18 percent of births in 2015.

C-sections continue to be overused in North America, where rates grew from 24 percent to 32 percent during that time; in Western Europe, with rates of 20 percent in 2000 and 26 percent in 2015; and in Latin America and the Caribbean, where rates jumped 32 percent to 44 percent.

Low- and middle-income countries saw the greatest disparity the use of C-sections, where wealthy women were six times more likely to have one than the poorest of those populations. The procedure is 1.6 times more likely to take place in a private institution rather than a public one, perhaps due to persistent shortages of staff and facilities in rural and vulnerable regions.

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