Trends in Cesarean Section Rates in Trinidad and Tobago, 2018-2025: A National Surveillance Study

Introduction Cesarean section (CS) rates in Trinidad and Tobago have historically been underdocumented. This study sought to present more recent national data on the CS rate in Trinidad and Tobago, explore and analyse the observed trends, and project future trajectories of CS rates to 2030. Methods This was a retrospective descriptive study utilizing aggregated, de-identified surveillance data on births and CS from 2018 to 2025. Chi-square tests of independence were performed to assess the association between the mode of delivery and the health sector (public or private) annually. Linear regression was used to assess time trends in CS rates and project CS rates for 2030. Results Analysis of 110,347 births revealed that the national CS rate increased from 29.6% (4,979/16,849) in 2018 to 38.4% (4,137/10,779) in 2025. The private sector CS rate was consistently higher than the public sector rate, increasing from 51.9% (910/1,753) in 2018 to 61.1% (580/949) in 2025, while the public sector rate increased from 27.0% (4,069/15,096) in 2018 to 36.2% (3,557/9,830) in 2025. The differences between public and private sector CS rates were statistically significant for all years (χ² range: 227.46-469.90; p < 0.001). Simple linear regression revealed that nationally, CS rates increased significantly across all levels (t-statistic range: 9.01-9.56; p < 0.001). The average annual increase in CS rates was 1.13 percentage points (95% CI: 0.84-1.42) nationally, 1.16 percentage points (95% CI: 0.86-1.45) in the public sector, and 1.33 percentage points (95% CI: 0.97-1.69) in the private sector. Linear trend projections forecast an increasing national CS rate of 43.5% (95% PI: 40.3%-46.6%) by 2030, 41.3% (95% PI: 38.0%-44.6%) in the public sector, and 68.3% (95% PI: 64.3%-72.2%) in the private sector. Conclusion The CS rate in Trinidad and Tobago is high and far exceeds the levels associated with reductions in maternal and neonatal mortality. The significant disparity between the public and private sector CS rates is suggestive of non-clinical factors potentially influencing the mode of delivery. Although limited by the use of aggregated data, the findings are suggestive of an urgent need to review indications for CS to ensure that the procedure is used appropriately and equitably.