Context

Over the past decades, the steady rise in caesarean section rates worldwide has led to increased research, debate and concern among clinicians, scientists, policymakers and governments, with sustained questions: What is the appropriate caesarean section rate? What is the rate or range that achieves best maternal and perinatal outcomes? Several ecological studies have been conducted to answer these questions at population level.1 In April 2015, WHO released a Statement on Caesarean Section Rates2 ,3 summarising the evidence on population-level caesarean section rates versus maternal/perinatal outcomes, replacing the earlier 1985 WHO Statement, which had suggested that rates higher than 10–15% were not justifiable.4