THE NUMBER OF babies born through caesarean section (C-section) almost doubled between 2000 and 2015 – from 12% to 21% of all births – according to a series of three papers published in The Lancet.

The studies found that while the life-saving surgery is still unavailable for many women and children in low-income countries and regions, the procedure is overused in many middle and high-income regions. 

C-section is a life-saving intervention for women and newborns when complications occur, such as bleeding, foetal distress, hypertensive disease, and babies in abnormal position. But, the surgery is not without risk for mother and child, and is associated with complications in future births.

It is estimated that 10-15% of births medically require this procedure due to complications, suggesting that average C-section use should lie between these levels.

Series lead author Dr Marleen Temmerman, Aga Khan University in Kenya said: “Pregnancy and labour are normal processes, which occur safely in most cases. 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.

“C-sections 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,” says  “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.”

Disparities in global C-section use 

The studies found that C-sections continue to be overused in North America, Western Europe, Latin America and the Caribbean, where rates increased by around 2% per year between 2000-2015.

The authors of the series of reports found that the increases in the procedure are attributed both to more births taking place in health institutions and to greater frequency of intervention through C-section in health facilities.

There were significant differences within low and middle-income countries, where the wealthiest women were six 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. The authors suggest that this could be explained by persistent issues with shortages in health facilities and staff in vulnerable and rural populations.

Harms associated with C-section overuse and underuse

C-section improves maternal, newborn and child survival when complications arise, and can also lower the risk of incontinence and prolapse. 

However, there are short and long-term risks associated with C-sections for mothers and children, and there are no benefits of C-section in cases without a medical indication. In these instances, women and children can be harmed or die from the procedure, especially when there are not sufficient facilities, skills, and health care available. 

Maternal death and disability is higher after C-section than vaginal birth. In particular, C-sections have a more complicated recovery for the mother, and lead to scarring of the womb, which is associated with bleeding, abnormal development of the placenta, ectopic pregnancy, stillbirth and preterm birth in subsequent pregnancies.

Professor Jane Sandall of King’s College London said: “Given the increasing use of C-section, particularly cases that are not medically required, there is a crucial need to understand the health effects on women and children. Greater understanding of this is important to help inform decision making by families, physicians, and policy makers.

“C-section is a type of major surgery, which carries risks that require careful consideration. The growing use of C-sections for non-medical purposes could be introducing avoidable complications, and we advocate that C-section should only be used when it is medically required.”