Connect

Member Research and Reports

Member Research and Reports

Harvard: Optimal Country-level C-section Rate may be as High as 19 Percent to Save Lives of Mothers and Infants

The most commonly performed operation in the world is cesarean section, and rates of cesarean childbirth delivery vary widely from country to country, from as few as 2 percent to more than 50 percent of live births. The World Health Organization recommends countries not exceed 10 to 15 percent (10 to 15 C-section deliveries per 100 live births) for optimal maternal and neonatal outcomes.

New research examining the relationship between C-section rates and maternal and neonatal mortality in 194 countries concludes that as the country-level C-section rate increases up to 19 percent, maternal and neonatal mortality rates decline. C-section delivery rates above 19 percent showed no further improvement in maternal and neonatal mortality rates.

The results were published in the Journal of the American Medical Association on December 1.

Researchers from Ariadne Labs, a joint center of Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, and Stanford University School of Medicine gathered and correlated national C-section, maternal and neonatal mortality rates in a single year (2012) for all 194 World Health Organization member countries. Mathematical modeling was used to impute C-section rates for countries where data was missing and to account for other contributing factors such as health expenditure. This is the first study to offer a comprehensive analysis of C-section rates for all WHO counties in a single year. That approach avoids bias caused by using data from varying years, since C-section rates and mortality change over time.

“On a nationwide level, our findings suggests there are many countries where not enough C-sections are being performed, meaning there is inadequate access to safe and timely emergency obstetrical care, and conversely, there are many countries where more C-sections are likely being performed than yield health benefits,” said Dr. Alex Haynes, primary investigator of the study, a surgeon and associate director of Ariadne Labs’ Safe Surgery Program. “This suggests on a policy level that benchmarks for C-section rates on country-wide level should be reexamined and could be higher than previously thought.” Read more