It is well documented that Cesarean section (C. section) rates have increased in many Latin American and Asian countries, and that many of these interventions are unnecessary. Fewer data are available on the evolution of C. section rates in sub-Saharan Africa, where concern centers on lack of access to necessary interventions.

We analyzed Demographic and Health Surveys (DHS) performed during two time periods in eight sub-Saharan African countries: Burkina Faso (1992 & 1999), Cameroon (1991 & 1998), Ghana (1993 & 1998), Kenya (1993 & 1998), Madagascar (1992 & 1997), Niger (1992 & 1998), Tanzania (1992 & 1996), and Zambia (1992 & 1996). We calculated C. section rates for deliveries that occurred during the three years preceding the interviews.

C. section rates decreased in six countries between 1991-1993 and 1996-1999: Burkina Faso (1.2% in 1992 vs. 1.1% in  1999), Ghana (4.5% in 1993 vs. 4.0% in 1998), Madagascar (0.9% in 1992 vs. 0.6% in 1997), Niger (0.8% in 1992 vs. 0.6% in 1998), Tanzania (2.6% in 1992 vs. 2.1% in 1996), and Zambia (2.7% in 1992 vs. 1.8% in 1996). In rural areas, C. section rates decreased in five countries: Ghana, Madagascar, Niger, Tanzania, and Zambia. Urban C.section rates decreased in four countries: Burkina Faso, Ghana, Kenya, and Zambia.

Our data show that access to C. sections is not improving in sub-Saharan Africa and suggest that it might be worsening.