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

Rele Ologunde, Joshua P. Vogel, Meena N. Cherian, Mariam Sbaiti, Mario Merialdi, James Yeats

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31 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)504.e1-504.e12
Number of pages12
JournalAmerican Journal of Obstetrics and Gynecology
Issue number5
Publication statusPublished - 1 Nov 2014
Externally publishedYes


  • cesarean delivery
  • low- and middle-income countries
  • obstetric services
  • surgery

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