Epidemiology of cesarean delivery: frequency, indications, related morbidity, and evidence-based strategies for optimal use

Cesarean delivery is a complex issue, involving medical, social, economic, and ethical dimensions. Cesarean delivery rates have steadily increased worldwide since 1990. Yet, important disparities exist between and within countries, with cesarean delivery rates ranging from less than 3% to more than 55% between 2000 and 2015. These differences often reflect inequities in access to obstetric care-particularly in rural or low-resource settings-and socioeconomic divides. In many low-income areas, underuse is driven by limited access to surgical services and geographical and financial barriers. In contrast, overuse is driven by cesarean delivery without clear medical indication, particularly among wealthier women…