Assessment of cesarean delivery availability in 26 low- and middle-income countries: a cross-sectional study

Am J Obstet Gynecol. 2014 Nov;211(5):504.e1-504.e12. doi: 10.1016/j.ajog.2014.05.022. Epub 2014 May 17.


Objective: We sought to assess the capacity to provide cesarean delivery (CD) in health facilities in low- and middle-income countries.

Study design: We conducted secondary analysis of 719 health facilities, in 26 countries in Africa, the Pacific, Asia, and the Mediterranean, using facility-based cross-sectional data from the World Health Organization Situational Analysis Tool to Assess Emergency and Essential Surgical Care.

Results: A total of 531 (73.8%) facilities reported performing CD. In all, 126 (17.5%) facilities did not perform but referred CD; the most common reasons for doing so were lack of skills (53.2%) and nonfunctioning equipment (42.9%). All health facilities surveyed had at least 1 operating room. Of the facilities performing CD, 47.3% did not report the presence of any type of anesthesia provider and 17.9% did not report the presence of any type of obstetric/gynecological or surgical care provider. In facilities reporting a lack of functioning equipment, 26.4% had no access to an oxygen supply, 60.8% had no access to an anesthesia machine, and 65.9% had no access to a blood bank.

Conclusion: Provision of CD in facilities in low- and middle-income countries is hindered by a lack of an adequate anesthetic and surgical workforce and availability of oxygen, anesthesia, and blood banks.

Keywords: cesarean delivery; low- and middle-income countries; obstetric services; surgery.

MeSH terms

  • Anesthesiology
  • Cesarean Section / statistics & numerical data*
  • Cross-Sectional Studies
  • Developing Countries / statistics & numerical data*
  • Equipment and Supplies / supply & distribution
  • Female
  • Global Health
  • Health Facilities / statistics & numerical data*
  • Health Services Accessibility / statistics & numerical data*
  • Health Services Needs and Demand / statistics & numerical data*
  • Health Workforce
  • Humans
  • Maternal Health Services / supply & distribution*
  • Obstetrics
  • Pregnancy