Inequities in the use of cesarean section deliveries in the world

Luz Gibbons, José M. Belizan, Jeremy A. Lauer, Ana P. Betran, Mario Merialdi, Fernando Althabe

Research output: Contribution to journalArticlepeer-review

216 Citations (Scopus)


OBJECTIVE: The purpose of this study was to describe the unequal distribution in the performance of cesarean section delivery (CS) in the world and the resource-use implications of such inequity. STUDY DESIGN: We obtained data on the number of CSs performed in 137 countries in 2008. The consensus is that countries should achieve a 10% rate of CS; therefore, for countries that are below that rate, we calculated the cost to achieve a 10% rate. For countries with a CS rate of >15%, we calculated the savings that could be made by the achievement of a 15% rate. RESULTS: Fifty-four countries had CS rates of <10%, whereas 69 countries showed rates of >15%. The cost of the global saving by a reduction of CS rates to 15% was estimated to be $2.32 billion (US dollars); the cost to attain a 10% CS rate was $432 million (US dollars). CONCLUSION: CSs that are potentially medically unjustified appear to command a disproportionate share of global economic resources.

Original languageEnglish
Pages (from-to)331.e1-331.e19
Number of pages19
JournalAmerican Journal of Obstetrics and Gynecology
Issue number4
Publication statusPublished - Apr 2012


  • cesarean section delivery
  • cost


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