Global inequities in cesarean section deliveries and required resources persist

WU, MICHAELLA L.; NICHOLS, PAULINA M.; CORMICK, GABRIELA; BETRAN, ANA P.; GIBBONS, LUZ; BELIZAN, JOSÉ M.

EUROPEAN JOURNAL OF OBSTETRICIA & GYNECOLOGY REPRODUTIVEBIOLOGY

ELSEVIER IRELAND LTD

Año: 2023 vol. 285 p. 31 - 40

0301-2115

Objective: The purpose of this study was to estimate the global distribution and financial cost associated with the inequities present in the use of cesarean sections (CS) worldwide. Study Design: We used the latest estimates on CS rates published by WHO and we adopted 10–15 % as the range of CS rates that are considered optimal for adequate use. We calculated the cost (in USD) to achieve CS rates of 10–15 % for countries that reported rates below 10 %. We also calculated the cost of CS rates in excess (>15 % and > 20 %) by estimating how much it would cost to reduce the rates to 10–15 % for each of those countries. Results: 137 countries are included in this analysis with updated data on CS rates between the years 2010 and 2018. Our analysis found that 36 countries reported CS rates < 10 %, whereas 91 countries reported CS rates > 15 % (a majority of which were > 20 %); only 10 countries reported CS rates between 10 and 15 %. The cost of CS exceeding a rate of 15 % is estimated to be $9,586,952,466 including inflation and exceeding 20 % is $7.169.248.033 (USD). The cost of achieving “needed” CS among countries with CS rates < 10 % is $612,609,418 (USD). The cost of cesarean sections exceeding 15 % has increased by 313 % between 2008 and more recent years, accruing $7 billion (USD) more in surplus since 2008. The reallocation of CS funding would save the global economy $9 billion (USD). Conclusion: Global inequities in CS performed and associated costs have increased since 2008, resulting in a disproportionate number of resources allocated.