Determinants of caesarean section rates in developed countries: supply, demand and opportunities for control

Objective To study population-level determinants of caesarean section trends in developed countries. Data sources/study setting National-level data (1980-2004) from developed countries on trends and potential determinants of caesarean section utilization. Study design The effect of maternal mortality, national income, hospital infrastructure and the health system financing and human resources profile on caesarean section rates was analysed with a dynamic econometric model. Data collection/extraction methods Annual data on utilization and potential determinants of caesarean section were obtained from health statistical services and international organizations. Principal findings The capacity of the health system to deliver surgical obstetric care, its financing structure, and possibly also its human resources profile, have stronger aggregate-level effects on caesarean section rates than does income. Conclusions Health system factors are potentially important aggregate-level determinants of caesarean section utilization which have been overlooked in debates focusing on the impact of women’s choices and doctors’ preferences.