Methods
Sources of data and estimation of national CS rates
We obtained national cesarean section rates from several data sources as explained below.
I. CS rates from routine statistical surveillance systems reports or national surveys from
government health offices were considered to provide nation-wide estimates (12 countries).
II. CS rates retrieved from the WHO Health Indicators Database [10], the WHO European
Health for all database [11], or the 2005 WHO World Health Report [12] were assumed as
national CS rates unless stated otherwise (52 countries).
III. CS rated reported in national surveys including the Demographic and Health Surveys (DHS).
The DHS reports from surveys conducted since 1990 [13] were included and considered
nationally representative (59 countries).
IV. CS rates published in the literature (13 countries) or personal comunication by the ministry
of health (1 country) were considered to provide country-level estimates if they specifically
stated that the figures represented country rates. In published manuscripts reporting hospital
CS rates (only considering births occurred at hospital level), we considered them national
rates if the country had a proportion of deliveries at health facilities >90%. For countries with
a proportion of hospital deliveries