The state of caesarean sections in South Africa: Challenges, unknowns and the way forward

The scarcity of safe and timely caesarean sections in much of Africa contrasts with SA's paradox of having one of the world's highest rates of caesarean section in the private sector - approaching 80% - yet persistently high maternal and perinatal mortality in rural public hospitals. This article addresses three challenges: (i) inequitable access to safe caesarean sections; (ii) high and rising caesarean section rates without evidence of better outcomes, raising concerns about overservicing, costs and respectful care; and (iii) research and data gaps. Closing these gaps requires action from all stakeholders to ensure equitable, high-quality and life-saving care for all.