Investigation of the change in the cesarean rate in Türkiye between 2008-2022

Title: Investigation of the change in the cesarean rate in Türkiye between 2008-2022 Aim: This study aims to investigate the temporal, regional, and sectoral changes in cesarean section (CS) rates in Türkiye between 2008 and 2022, and to evaluate these findings through a comparative analysis with international data. Methods: Designed as a cross-sectional and descriptive study, data were obtained from the "Health Statistics Yearbooks" published by the Ministry of Health of the Republic of Türkiye. Total and primary CS rates were analyzed according to geographical regions and types of healthcare institutions. The findings were also compared with international rates. Line and bar graphs were used for data presentation. Results: The total CS rate increased from 36.7% in 2008 to 60.1% in 2022. Primary CS rates showed a more modest rise, increasing from 27.2% in 2009 to 31.1% in 2022, suggesting the overall increase was predominantly due to repeat cesarean sections. Sectoral analysis revealed the highest cesarean rates (both total and primary) in private hospitals. Although regional variations existed, total and primary CS rates exhibited an increasing trend in all regions. In 2022, the Mediterranean Region recorded the highest CS rate (69.4%), whereas the lowest rate was observed in Northeastern Anatolia (43.9%). Between 2008–2022, the greatest increase occurred in Southeastern Anatolia (36.3%), while Western Marmara experienced the smallest rise (12.7%). Compared internationally, Türkiye's CS rate is substantially higher than the averages of the Organisation for Economic Co-operation and Development (OECD, 28%), the European Union (EU, 28.8%), and the World Health Organization (WHO) European Region (27.7%). Indeed, Türkiye had the highest cesarean rate among these regions as of 2022. Conclusions: Cesarean delivery rates in Türkiye increased significantly at the national, regional, and sectoral levels between 2008–2022. This marked increase cannot be explained solely by medical indications, suggesting a potential association with healthcare delivery models and patient-provider preferences factors. Keywords: Cesarean section, repeated birth, birth rate, delivery, Türkiye