Stemming the global caesarean section epidemic

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The major rise in caesarean sections around the world is called unprecedented and unjustified in a new Lancet Series on optimising caesarean section use published today.

When medically indicated, such as in placenta preavia, fetal distress, or abnormal positioning, caesarean sections save the lives of women and babies. Underuse due to lack of access clearly exists in some areas, and is associated with maternal and perinatal harms. But overuse and its implications are now of growing concern. Population rates above 10–15% are considered excessive. Women who do not need a caesarean section and their infants can be harmed or die from the procedure, especially when done in the absence of adequate facilities, skills, and comprehensive health care.

The Series shows that the global rate of caesarean birth has doubled in the past 15 years to 21%, and is increasing annually by 4%. While in southern Africa use of caesarean section is less than 5%, the rate is almost 60% in some parts of Latin America, including in Brazil where we will launch the Lancet Series at the World Congress of Gynecology and Obstetrics (FIGO) on Oct 18. Of the 6·2 million unnecessary caesareans done each year, half are in Brazil and China. The wide variations reported between regions, within countries, and between groups of women confirm that caesarean section use is not evidence-based. Any increases in obesity, age, and nulliparity among populations of women are not enough to explain increases. Addressing the non-medical reasons that drive caesarean sections, therefore, is key to reducing inappropriate use.

Caesarean section—the most common surgery in many countries around the world—is a procedure that can save women’s and babies’ lives when complications occur during pregnancy or birth. However, caesarean section use for non-medically indicated reasons is a cause for concern because the procedure is associated with considerable short-term and long-term effects and health-care costs. Caesarean section use has increased over the past 30 years in excess of the 10–15% of births considered optimal, and without significant maternal or perinatal benefits. A three-part Lancet Series on Optimising Caesarean Section Use reviews the global epidemiology and disparities in caesarean section use, as well as the health effects for women and children, and lays out evidence-based interventions and actions to reduce unnecessary caesarean sections.

Access the 1st paper of the Lancet series – Global epidemiology of use of and disparities in caesarean sections

Access the 2nd paper of the Lancet Series – Short-term and long-term effects of caesarean section on the health of women and children

Access the 3rd paper of the Lancet Series – Interventions to reduce unnecessary caesarean sections in healthy women and babies

Access the 1st Comments paper about the series – FIGO position paper: how to stop the caesarean section epidemic

Access the 2nd Comments paper about the series – Appropriate use of caesarean section globally requires a different approach

Access the 3rd Comments paper about the series – Strategic measures to reduce the caesarean section rate in Brazil

Access the Profile paper related to the series – Ana Pilar Betrán: seeking the optimum use of caesarean section

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