Responses to increased rates of caesarean births.

Performing caesarean sections without medical need exposes women and babies to unnecessary risks without clear benefits. Yet the global number of caesarean sections has continued to rise considerably over the years, with caesarean sections increasingly performed before the onset of labour and among women at low risk of birth complications. In recent years, considerable efforts have been made to reduce unnecessary caesarean sections. However, interventions that aim to reduce such births are complex, have mixed outcomes, do not translate well between settings and lack clear evidence on which components or mechanisms drive success. In this article, we outline a three-step pathway for implementing interventions that aim to optimize caesarean use: (i) conduct formative research to identify context-specific needs and priorities; (ii) design evidence-based, multifaceted interventions; and (iii) ensure implementation through meaningful stakeholder engagement. Finally, we emphasize how improving the quality of care during childbirth is key to achieving optimal and equitable use of caesarean sections.