• Rele Ologunde, Joshua P Vogel, Meena N Cherian, Mariam Sbaiti, Mario Merialdi, and James Yeats.
• Faculty of Medicine, School of Public Health, Imperial College London, St Mary's Hospital, London, United Kingdom; Emergency and Essential Surgical Care Program, Health Systems and Innovation. Electronic address: Rele.ologunde09@imperial.ac.uk.
• Am. J. Obstet. Gynecol. 2014 Nov 1;211(5):504.e1-504.e12.

ObjectiveWe sought to assess the capacity to provide cesarean delivery (CD) in health facilities in low- and middle-income countries.Study DesignWe 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.ResultsA 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.ConclusionProvision 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.Copyright © 2014 Elsevier Inc. All rights reserved.

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