• Mohamad Irani and Shad Deering.
• Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, USA. Electronic address: mohamad.irani@hotmail.com.
• Int J Gynaecol Obstet. 2015 Oct 1; 131 (1): 30-4.

BackgroundMost maternal deaths occur in low-income countries where access to appropriate medical care is restricted.ObjectivesTo evaluate rates of cesarean deliveries and identify barriers to this mode of delivery in low-income countries.Search StrategyA review of Medline and PubMed was performed to identify reports published in English or French using the keywords "cesarean section," "maternal mortality," and "developing countries."Selection CriteriaStudies investigating the obstacles to cesarean delivery and plans to overcome them in low-income countries were included.Data Collection And AnalysisData from included studies were extracted and analyzed.Main ResultsStudies from 16 countries in Sub-Saharan Africa were included. The average rate of cesarean delivery was 3.6% (range 1.5%-7.1%). The rate was negatively correlated with the maternal mortality ratio (r=-0.63; P=0.005), neonatal mortality rate (r=-0.81; P<0.001), and infant mortality rate (r=-0.80; P<0.001). Major barriers to achieving higher rates of cesarean deliveries include poverty, limited access to healthcare services, and a shortage of skilled providers.ConclusionsMaternal and infant mortality rates could be lowered by increasing access to cesarean delivery. Additional education of patients and providers, establishment of more heath facilities, and governmental support of obstetric care could help to reach this goal.Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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