Topic description / abstract:

Caesarean section rates have been rising in most middle and high-income countries worldwide. The World Health Organization advises against overuse of C-sections, and recommends a population-wide C-section rate of 10-15% as optimal. There is broad agreement that the recent steep increase in C-section rates, to levels of 50% in some countries and higher, is largely due to non-medical drivers. However, trends in the maternal population that might contribute to the increase have been largely ignored when evaluating C-section use. Here I present evidence for an evolutionary and a demographic effect that contribute to increasing C-section rates. I show results from a mathematical model and from a population-based study using 24 years of individual-level data from Austria. Based on these findings, I argue that health politicians and managers must keep in mind that the maternal population is not static when aiming at reducing unnecessary C-section use.

Biographical note:

Barbara Fischer is a postdoctoral fellow at the KLI and lecturer at the University of Vienna. She is an evolutionary biologist with a background in mathematics. Her main research interest is the evolution of human childbirth and pelvic morphology. She studied biology and mathematics at the University of Vienna, Austria and at University College Cork, Ireland, and completed her PhD in theoretical biology at the University of Berne, Switzerland. As a PhD student, she was also a research assistant at the International Institute of Applied Systems Analysis (IIASA) in Laxenburg. She subsequently worked as a post-doc at the University of Oslo, Norway, on topics in evolutionary theory. Beyond her research, she writes popular science articles for a general audience and has published a textbook for high school biology.