Doctors' use of Caesarean section to deliver babies has nearly doubled in 15 years to reach "alarming" proportions in some countries, a study says.
Rates surged from about 16 million births (12%) in 2000 to an estimated 29.7 million (21%) in 2015, the report in the medical journal The Lancet said.
The nation with the highest rate for using the surgery to assist childbirth is the Dominican Republic with 58.1%.
Doctors say in many cases the use of the medical procedure is unjustified.
Until recently, the World Health Organization (WHO) suggested that Caesarean section - or C-section - rates of more than 15% were excessive.
The study analysed data from 169 countries using statistics from 2015 - the most recent year for which the information is available.
- What does the study say?
It says there is an over-reliance on Caesarean section procedures - when surgery is used to help with a difficult birth - in more than half of the world's nations.
Researchers reported a rate of more than 50% in the Dominican Republic, Brazil, Egypt and Turkey, though Brazil implemented a policy in 2015 to reduce the number of Caesarean sections performed by doctors.
They also found huge disparities in the use of the technique between rich and poor nations. In some circumstances, particularly in sub-Saharan Africa, the surgery is unavailable when it is genuinely required.
Use in 2015 was up to 10 times more frequent in the Latin America and Caribbean region, at 44% of births, than in the west and central Africa region, where it was used in just 4% of cases.
The study urges healthcare professionals, women and their families to only choose a Caesarean when it is needed for medical reasons - and for more education and training to be offered to dispel some of the concerns surrounding childbirth.
- Why is surgery carried out unnecessarily?
Prof Sandall says that reasons vary from country to country and that with poorer nations, choices are extremely limited.
"Globally, drivers for the increasing rates vary between countries and include a lack of midwives to prevent and detect problems, loss of medical skills to confidently and competently attend a [potentially difficult] vaginal delivery, as well as medico-legal issues."
She adds that financial incentives exist for both doctor and hospital with the certainty of planned day-time deliveries, especially in private practices.
"In some cases the trend is system-driven. In Brazil, for example, the free public healthcare system is of poorer quality and pregnant mothers who can't afford private healthcare might be offered the procedure to help clear patients more quickly through the system."
"In China, a shortage of midwives can result in a lack of screening, meaning not only that necessary medical checks are not being carried out, but that there is a lack of expert help with assisting childbirth."
Variation exists within countries between the urban wealthy giving birth in private facilities where there are high rates of Caesarean section and the rural poor without access to the procedure, Prof Sandall says.
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