Caesarean section rates in public vs private hospitals in Europe : a systematic review and meta-analysis using the Robson ten group classification system
Ebadi, Sara LU ; Radaf, Viktoria El LU ; Mahmood, Tahir ; Savona-Ventura, Charles and Zaigham, Mehreen LU
(2026)
In European Journal of Obstetrics, Gynecology, and Reproductive Biology
318.
p.1-14
- Abstract
INTRODUCTION: Since the last two decades, there has been a dramatic rise in caesarean sections (CS) throughout the world. This increase has been seen even in Europe, where rates vary significantly from 17% in Northern Europe to 56% in the South. Although, CS can be a lifesaving intervention when medically necessary, non-essential CS are associated with short- and long-term complications for both the mother and newborn. To curb this rising trend, it is important to understand underlying causes behind regional disparities, including differences between public and private hospitals.
OBJECTIVE: To investigate variations in CS rates between public and private hospitals across European regions and at a country level using the Robson Ten... (More)
INTRODUCTION: Since the last two decades, there has been a dramatic rise in caesarean sections (CS) throughout the world. This increase has been seen even in Europe, where rates vary significantly from 17% in Northern Europe to 56% in the South. Although, CS can be a lifesaving intervention when medically necessary, non-essential CS are associated with short- and long-term complications for both the mother and newborn. To curb this rising trend, it is important to understand underlying causes behind regional disparities, including differences between public and private hospitals.
OBJECTIVE: To investigate variations in CS rates between public and private hospitals across European regions and at a country level using the Robson Ten Group Classification.
METHODS: A systemic review of studies published between 1st January 2000 and 12th March 2025 was conducted using MEDLINE/PubMed, CINAHL, EMBASE, Global Index Medicus, Web of Science and Cochrane library, analysing CS rates in 25 European countries. All studies reporting births in Europe, Robson group, written in English or Swedish were included. The developed protocol was prospectively registered in PROSPERO (Registration number 513579). Meta-analysis using absolute numbers and percentages was conducted to compare the birth rates at country and regional levels. To assess the risk of bias, two reviewers independently evaluated the quality of the studies included using a modified Newcastle-Ottawa Scale adapted for cohort studies.
RESULTS: Of 1385 articles, 46 were eligible for inclusion in the final analysis. A total of 12 505939 births were analysed, with 8 543803 (68.3%) occurring in public hospitals and 3 962136 (31.7%) in private hospitals. Overall, Southern Europe illustrated the highest CS rate (54.9% of all births) as compared to Northern Europe (16.9%). There was a lack of reporting from private hospitals, with data only for Southern Europe, where CS rates were significantly higher in private (73.1%) as compared to public (40.9%) hospitals. The largest differences were seen for low-risk women Robson Group 1, 2, 3 and 4 (private vs public: 67.8 vs 28%, 67.6 vs 39.7, 26.9 vs 9.1% and 38 vs 18% respectively).
CONCLUSION: High CS rates were observed across Europe, with Southern Europe reporting the highest levels. Rates were consistently higher in private compared to public hospitals. In both settings, Group 5 (women with a previous CS) was the largest contributor to the overall CS rate. However, low-risk women in private hospitals (Groups 1 and 2) had twice the CS rates compared with public hospitals. These findings highlight that the excess CS burden in private hospitals is largely driven by unnecessary procedures in low-risk groups. There is an urgent need for interventions that promote evidence-based care and reduce unnecessary CS especially among low-risk women.
(Less)
- author
- Ebadi, Sara
LU
; Radaf, Viktoria El
LU
; Mahmood, Tahir
; Savona-Ventura, Charles
and Zaigham, Mehreen
LU
- organization
- publishing date
- 2026-02
- type
- Contribution to journal
- publication status
- published
- subject
- in
- European Journal of Obstetrics, Gynecology, and Reproductive Biology
- volume
- 318
- article number
- 114921
- pages
- 1 - 14
- publisher
- Elsevier
- external identifiers
-
- pmid:41506012
- ISSN
- 0301-2115
- DOI
- 10.1016/j.ejogrb.2025.114921
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.
- id
- 339b9c21-2a39-4c2c-88a0-5fab7dae925c
- date added to LUP
- 2026-01-13 09:28:02
- date last changed
- 2026-01-13 10:53:17
@article{339b9c21-2a39-4c2c-88a0-5fab7dae925c,
abstract = {{<p>INTRODUCTION: Since the last two decades, there has been a dramatic rise in caesarean sections (CS) throughout the world. This increase has been seen even in Europe, where rates vary significantly from 17% in Northern Europe to 56% in the South. Although, CS can be a lifesaving intervention when medically necessary, non-essential CS are associated with short- and long-term complications for both the mother and newborn. To curb this rising trend, it is important to understand underlying causes behind regional disparities, including differences between public and private hospitals.</p><p>OBJECTIVE: To investigate variations in CS rates between public and private hospitals across European regions and at a country level using the Robson Ten Group Classification.</p><p>METHODS: A systemic review of studies published between 1st January 2000 and 12th March 2025 was conducted using MEDLINE/PubMed, CINAHL, EMBASE, Global Index Medicus, Web of Science and Cochrane library, analysing CS rates in 25 European countries. All studies reporting births in Europe, Robson group, written in English or Swedish were included. The developed protocol was prospectively registered in PROSPERO (Registration number 513579). Meta-analysis using absolute numbers and percentages was conducted to compare the birth rates at country and regional levels. To assess the risk of bias, two reviewers independently evaluated the quality of the studies included using a modified Newcastle-Ottawa Scale adapted for cohort studies.</p><p>RESULTS: Of 1385 articles, 46 were eligible for inclusion in the final analysis. A total of 12 505939 births were analysed, with 8 543803 (68.3%) occurring in public hospitals and 3 962136 (31.7%) in private hospitals. Overall, Southern Europe illustrated the highest CS rate (54.9% of all births) as compared to Northern Europe (16.9%). There was a lack of reporting from private hospitals, with data only for Southern Europe, where CS rates were significantly higher in private (73.1%) as compared to public (40.9%) hospitals. The largest differences were seen for low-risk women Robson Group 1, 2, 3 and 4 (private vs public: 67.8 vs 28%, 67.6 vs 39.7, 26.9 vs 9.1% and 38 vs 18% respectively).</p><p>CONCLUSION: High CS rates were observed across Europe, with Southern Europe reporting the highest levels. Rates were consistently higher in private compared to public hospitals. In both settings, Group 5 (women with a previous CS) was the largest contributor to the overall CS rate. However, low-risk women in private hospitals (Groups 1 and 2) had twice the CS rates compared with public hospitals. These findings highlight that the excess CS burden in private hospitals is largely driven by unnecessary procedures in low-risk groups. There is an urgent need for interventions that promote evidence-based care and reduce unnecessary CS especially among low-risk women.</p>}},
author = {{Ebadi, Sara and Radaf, Viktoria El and Mahmood, Tahir and Savona-Ventura, Charles and Zaigham, Mehreen}},
issn = {{0301-2115}},
language = {{eng}},
pages = {{1--14}},
publisher = {{Elsevier}},
series = {{European Journal of Obstetrics, Gynecology, and Reproductive Biology}},
title = {{Caesarean section rates in public vs private hospitals in Europe : a systematic review and meta-analysis using the Robson ten group classification system}},
url = {{http://dx.doi.org/10.1016/j.ejogrb.2025.114921}},
doi = {{10.1016/j.ejogrb.2025.114921}},
volume = {{318}},
year = {{2026}},
}