Ecological studyindependent cross-checkabstract checked I-ORG-111 standard review

Caesarean rates around the world

Trends and projections of caesarean section rates: global and regional estimates.

Overview

Betran AP et al.. BMJ Glob Health 2021 · PMID 34130991 · DOI 10.1136/bmjgh-2021-005671

About 1 in 5 births worldwide is by caesarean; in Egypt it is about half of all births, one of the highest rates globally.

Does the study support the specific claim? Partly · Methodological quality: moderate

Study explained simply

What did the researchers want to find out?: Describe global caesarean trends
How was the study done?: Analysis of national data from 154 countries
How many people, animals or samples were studied?: 94.5% of world births
What was actually found?: 21.1% global rate; Egypt 51.8%
How large was the observed effect?: n/a
What do the results mean in everyday life?: Caesarean is likely overused in some countries such as Egypt
What are the study's limitations?: Data quality varies
What does it say about Elawady's specific claim?: Supports concern about overuse; not refusal of all caesareans
Do the results apply to Germany and Europe?: Europe also included
What can explicitly not be concluded from this study?: Does not show which individual caesareans were unnecessary

Authors: Betran AP et al.
Journal: BMJ Glob Health
Year: 2021
Identifier: PMID 34130991 DOI 10.1136/bmjgh-2021-005671
Verification: verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: Non-commercial support (PubMed); details not read.

Current global and regional CS rates, trends since 1990 and projections to 2030.

Study design: Ecological study – Global analysis of nationally representative CS rate data with trend analysis and ARIMA projections
Population: Live births in 154 countries
Country: Global
Period: 1990-2018; projections to 2030
Sample size: 154 countries covering 94.5% of world live births
Inclusion and exclusion criteria: Nationally representative data (routine systems, household surveys)

Exposure / intervention: Calendar time / region
Comparator: Regions
Endpoints: CS rate
Statistical methods: Weighted averages, piecewise trend analysis, ARIMA projections

Results: 21.1% of women gave birth by caesarean worldwide (2010-2018), from 5% in sub-Saharan Africa to 42.8% in Latin America and the Caribbean. Greatest increases in Eastern Asia, Western Asia and Northern Africa (44.9, 34.7 and 31.5 percentage points). Projected 28.5% worldwide by 2030. Results section of the open full text: Egypt had the fourth-highest CS rate worldwide (51.8%) and showed an increase of more than 50 percentage points over the period.
Absolute risks: Egypt 51.8% vs world 21.1%.
Authors' conclusion: CS use has steadily increased worldwide; unmet need and overuse coexist and must both be addressed.

Descriptive; Egypt figure from the results text of the open full text.

Shows that caesarean overuse is real and that Egypt has one of the highest rates in the world.

WHO statement: necessary CS saves lives.

Includes European rates (Romania highest in Europe at 46.9%).

Supports concern about excessive caesarean use, especially in Egypt; says nothing in favour of refusing indicated caesareans.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	moderate
Risk of bias	not assessable
Precision of results	not applicable
Directness	indirect
Reproducibility	replicated
Consistency with the overall evidence	consistent
Regional transferability	high
Adequacy of the interpretation (by the archive)	not applicable

Egypt-specific Robson-group data.