Why It Matters
Why are C-section rates so high in middle- and high-income countries? It's not because women demand it. The true reasons are complex.
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The Global Epidemic of Unneeded Cesarean Sections

By Pierre Barker | Wednesday, May 17, 2017
The Global Epidemic Of Unneeded Cesarean Sections

Ask anyone, as I have, in a range of health care and academic settings: why are cesarean section (C-section) rates so high in middle- and high-income countries? You’re likely to hear that “women demand it.”

It turns out that this is absolutely not the case. In study after study, women indicate that they want what’s best for them and their babies, and mostly want a C-section only if it’s medically indicated. According to the World Health Organization (WHO), there is no benefit to mother or baby if the average C-section rate is higher than 10 percent for any given country, and overall, you are likely to see worse outcomes for babies as rates climb over 20 percent. And the WHO has laid out very clearly who should be considered for C-section and who should not.

So why have C-section rates progressively increased in every region of the world over the past three decades? Why do average C-section rates exceed 15 percent in every country outside of sub-Saharan Africa?

To answer those questions, it’s helpful to look at which countries have the lowest and highest rates. Low-income countries have low rates because they just don’t have the resources — trained medical staff, operating rooms — to provide life-saving C-sections when needed. The countries with the most evolved health systems — mostly those in northern Europe — have the lowest rates, but even there, none are below the WHO-recommended 15 percent threshold.

Read more at HuffPost.

Pierre Barker, MD, is IHI Chief Global Programs and Partnerships Officer and a contributor to HuffPost. Follow him on Twitter @PierreMBarker.


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