While the life-saving surgery is still unavailable for many women and children in low-income countries and regions, the procedure is overused in many middle- and high-income settings, said researchers, including those from Ghent University in Belgium.
Globally, C-section use has increased by 3.7 per cent each year between 2000-2015 - rising from 12 per cent of live births (16 million of 131.9 million) in 2000, to 21 per cent of live births (29.7 million of 140.6 million) in 2015, researchers said. Since C-sections can be life-saving for women who experience childbirth complications such as excessive bleeding, fetal distress and blood pressure issues - and their babies - increased access can make a big difference for maternal and child health.
"C-section is a type of major surgery, which carries risks that require careful consideration".
In 15 countries, more than 40% of births happen through this procedure.
But the procedure can lead to scarring of the womb, which heightens the risk of complications during future births, such as from bleeding, abnormal development of the placenta, ectopic pregnancy, stillbirth and preterm birth. But 60% of the 169 countries reviewed in the research are above this range, while a quarter of the states are below it, putting mothers and children at risk, according to the study based on the data gathered by World Health Organization and UNICEF.
In other words, the surgery should be used sparingly.
Today, however, many countries are failing to meet this recommendation - which is not flawless but does provide guidance.
New research shows that in just 15 years, the worldwide rate of c-section births has almost doubled.
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"In cases where complications do occur, C-sections save lives, and we must increase accessibility in poorer regions, making C-sections universally available, but we should not overuse them", Temmerman said in a journal news release. "Disparities are overwhelming between sub-Saharan Africa (4.1% of cesarean sections) and Latin America and the Caribbean, where the rate reached 44.3% in 2015", Temmermman added.
But the research found wildly varying country rates of caesarean section use, often according to economic status: In at least 15 countries, more than 40 per cent of births are performed using the practice, often on wealthier women in private facilities.
Part of this trend is being driven by income and access to health facilities.
Some women choose an elective cesarean delivery because it allows them to skip the pain and uncertain timing of natural labor.
Moreover, the study showed significant disparities within low and middle-income countries.
"Although there is nearly universal consensus that c-section use has increased beyond the reasonable level of need in many countries, effective interventions to optimise use have proven elusive", explains Ana Pilar Betran, a key contributor to the series and an expert in public health and obstetrics at the WHO. "Joint actions with governmental bodies, the health care insurance industry, and women's groups are urgently needed to stop unnecessary C-sections and enable women and families to be confident of receiving the most appropriate obstetric care for their individual circumstances".
"Given the increasing use of C-section, particularly cases that are not medically required, there is a crucial need to understand the health effects on women and children".
The World Congress of Gynecology and Obstetrics (FIGO) advocates several measures to limit the abuse of caesareans: to apply a single rate for births, by caesarean section or not, to force hospitals to publish their statistics, to better inform women of the risks and improve training in natural birth.