The Overuse of Cesarean Section: Medical, Legal, Research, and Economical Pitfalls

An attempt was made to: (1) estimate the use and overuse of medically indicated and elective Cesarean sections (CS) in countries with reported lower and higher rates of CS; (2) understand the resource-use implications of indicated and elective CS in countries with lower and higher rates of CS. CS rates published in the literature, as well as in the WHO database were considered to provide country-level estimates of CS rates. Unit costs for the inputs identified were derived from a search of literature and databases, as well as from consultation with costing experts. Findings indicate on an unequal global distribution of CS. Medically not indicated and elective CS posses legal–medical, as well as unequivocal economical pitfalls, and appear to command a disproportionate share of global economic resources. Excessive CS could have important negative implications for health equity within and across countries. If all resources used on elective CS could be allocated to countries with undeserved population, the medically indicated procedures could be fully financed, and there would be a surplus of resources with a value of nearly US/$2 billion. Finally, studies have attempted to model the impact of tort reform on primary and repeat CS rates and have shown that modest improvements in the medical–legal climate may result in reductions in CS. It is concluded that both caps on noneconomic damages and reductions in physician malpractice premiums would result in fewer CS. Copyright Springer Science+Business Media New York 2015