International caesarean section rates: the rising tide

Historically, the introduction of caesarean section surgery was associated with an improvement in maternal and perinatal health outcomes. WHO has stated that no empirical evidence exists for an ideal caesarean rate, but “what matters most is that all women who need caesarean sections actually receive them”.1 In areas with very high mortality rates, such as Africa, inadequate availability of caesarean section contributes to substantial maternal and perinatal morbidity and mortality.2 Conversely, in many developed countries, concerns exist about high rates of caesarean section, since increasing rates of this procedure show little evidence of leading to further improvement in perinatal outcomes.