Today, some developed countries apparently have begun to control the rise in cesarean deliveries, but in others, cesarean delivery rates continue to rise. This survey determined incidence rates of operative delivery in relation to demographic, socioeconomic, and healthcare variables in 19 Latin American countries (all except Nicaragua, from which recent data are not available). According to data obtained since 1990, seven countries had cesarean delivery rates less than 15 percent, and in the other 12 countries, rates ranged from 17 to 40 percent. The latter countries represented 81 percent of all deliveries in the region. Three countries had cesarean delivery rates exceeding 50 percent in private hospitals. Nations whose rates were less than 15 percent also had relatively low proportions of hospital deliveries and births assisted by skilled attendants. Cesarean delivery rates correlated positively and significantly with the per capita gross national product, the size of the urban population, and the number of physicians. In the 12 countries with cesarean delivery rates higher than 15 percent, approximately 2.2 million operative deliveries were done each year. In the region as a whole, and using 15 percent as the medically justified limit, an estimated 850,000 unnecessary cesarean deliveries were done annually in the countries surveyed.Effective efforts to control cesarean delivery rates will require participation by public health authorities, medical associations, medical schools, physicians, midwives, and nurses. The media and general population also will have to take part. What is needed are scientifically verified medical alternatives. Six Latin American countries are currently engaged part in a multicenter study of how obtaining a mandatory second medical opinion might influence cesarean delivery rates.Br Med J 1999;319:1397–1402
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