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Thirty years of the World Health Organization’s target caesarean section rate: time to move on

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The 2009 edition of the World Health Organization Monitoring emergency obstetric care handbook was the first since 1985 not to recommend a maximum caesarean section (CS) rate of 15%.1 In its place was the statement, “there is no empirical evidence for an optimum percentage or range of percentages”, and a concession that “what matters most is that all women who need caesarean sections actually receive them”. Despite this change, a perception remained that CSs above such a “target” rate were unnecessary.2

In 2015, a new WHO standalone policy statement was released, restating that “every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate”.3 However, the document justified a return to the old recommendation, recognising that “the international community has increasingly referenced the need to revisit the 1985 recommended rate”:

Since 1985, the international healthcare community has considered the ideal rate for caesarean sections to be between 10% and 15% … there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure … caesarean sections are associated with short and long term risk which can extend many years…