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Cited by 1,562Maternal and Perinatal Health InterventionsGlobal Health and SurgeryReproductive Health and Contraception

Trends and projections of caesarean section rates: global and regional estimates

Open access
Betran, Ana Pilar, Ye, Jiangfeng, Moller, Ann-Beth, Souza, João Paulo, Zhang, Jun·2021·BMJ Global Health
DOI 10.1136/bmjgh-2021-005671PMC PMC8208001
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Abstract

Background: The caesarean section (CS) rate continues to increase across high-income, middle-income and low-income countries. We present current global and regional CS rates, trends since 1990 and projections for 2030. Methods: We obtained nationally representative data on the CS rate from countries worldwide from 1990 to 2018. We used routine health information systems reports and population-based household surveys. Using the latest available data, we calculated current regional and subregional weighted averages. We estimated trends by a piecewise analysis of CS rates at the national, regional and global levels from 1990 to 2018. We projected the CS rate and the number of CS expected in 2030 using autoregressive integrated moving-average models. Results: Latest available data (2010–2018) from 154 countries covering 94.5% of world live births shows that 21.1% of women gave birth by caesarean worldwide, averages ranging from 5% in sub-Saharan Africa to 42.8% in Latin America and the Caribbean. CS has risen in all regions since 1990. Subregions with the greatest increases were Eastern Asia, Western Asia and Northern Africa (44.9, 34.7 and 31.5 percentage point increase, respectively) while sub-Saharan Africa and Northern America (3.6 and 9.5 percentage point increase, respectively) had the lowest rise. Projections showed that by 2030, 28.5% of women worldwide will give birth by CS (38 million caesareans of which 33.5 million in LMIC annually) ranging from 7.1% in sub-Saharan Africa to 63.4% in Eastern Asia . Conclusion: The use of CS has steadily increased worldwide and will continue increasing over the current decade where both unmet need and overuse are expected to coexist. In the absence of global effective interventions to revert the trend, Southern Asia and sub-Saharan Africa will face a complex scenario with morbidity and mortality associated with the unmet need, the unsafe provision of CS and with the concomitant overuse of the surgical procedure which drains resources and adds avoidable morbidity and mortality. If the Sustainable Development Goals are to be achieved, comprehensively addressing the CS issue is a global priority.

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  • In low- and middle-income countries, cesarean decisions may reflect personal or provider preferences, institutional pressures, or sociocultural beliefs rather than evidence-based clinical criteria.

    “This issue is especially salient in low‐ and middle‐income countries (LMICs), where cesarean decisions may reflect personal or provider preferences, institutional pressures, or sociocultural beliefs rather than evidence‐based clinical criteria [3, 4].”

    From Determinants of Delivery Mode Preferences and Decision‐Making Among Jordanian Women: A Cross‐Sectional Study (2025) · cites this paper as [3]

    The Discussion says that women’s and families’ preferences, health professionals’ beliefs, remuneration, and healthcare structures contribute to rising caesarean use worldwide; it also recognizes non-medical factors in decisions about mode of birth. The Conclusion identifies overuse in Southern Asia and sub-Saharan Africa, but the paper does not specifically establish that the listed factors shape decisions more in LMICs than elsewhere. (LLM, conf=0.82)

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  • The worldwide average for caesarean sections is approximately 21%.

    “The worldwide average for caesarean sections stands at approximately 21%.36”

    From Determinants of the choice of delivery mode in pregnant women: a convergent parallel mixed-methods study protocol (2026) · cites this paper as [36]

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Research works printed but not linked: 22

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Cited by

Sorted by citations

Authors
Betran, A. P., Ye, J., Moller, A.-B., Souza, J. P., & Zhang, J.
Affiliations
  • Shanghai Jiao Tong University (CN)
  • World Health Organization (CH)
  • Universidade de São Paulo (BR)
ORCID
Venue
BMJ Global Health
Publisher
BMJ
Published
2021-06
Volume
6
Issue
6
Pages
e005671
ISSN
2059-7908 (ISSN-L)
DOI
10.1136/bmjgh-2021-005671
PMC
PMC8208001
OpenAlex
W3166989839
Cited by
1,562
References
2
Citations by year
2026: 340 · 2025: 365 · 2024: 393 · 2023: 302 · 2022: 143 · 2021: 18
FWCI
194.37
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ Global Health (publishedVersion, cc-by-nc-sa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Bill and Melinda Gates Foundation
  • HRP – UNDP · UNFPA · UNICEF · WHO · World Bank Special Programme of Research, Development and Research Training in Human Reproduction
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
cesarean section rate, global trends, regional disparities, 2030 projections, low- and middle-income countries, sub-Saharan Africa, East Asia, Sustainable Development Goals, maternal health
MeSH terms
Asia, Asia, Western, Cesarean Section, Female, Humans, Poverty, Pregnancy, Africa South of the Sahara

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