Public Health aspects of Cesarean section including overuse and underuse of the procedure

Caesarean section (CS) is lifesaving medical procedure that is able to avert both maternal and neonatal mortality. However, across the globe an estimated 3.2 million necessary CSs do not happen in low income countries and an estimate of 6.2 million unnecessary CSs happen in middle and high income countries. The overuse and underuse of this procedure driven by both the supply-side (such as resources within the health system, healthcare policy and strategies, health financing systems and perceptions of the healthcare professional) and demand-side (such as socio-economic status, population preference and perceptions and trust in health system) determinants. There are stark inequities in CS rates between and within regions and countries. Many regions across the globe (Eastern Asia, Northern Europe, Central America, Southern America, Northern America and Oceania) have over double recommended optimal rates, whereas several African regions (Eastern, Middle and Western) have dangerously low rates. Both of these have detrimental impacts on maternal and neonatal outcomes. There is a need now for health policy and decision makers at both national and facility level to try and optimize the CS rates through facilitating strategies that promote positive human relations and encourage standardized evidence based care.