The number of births delivered by caesarean section has risen sharply worldwide in recent decades, with Greece now recording the highest rate in the European Union, according to new research.

In 2023, caesarean deliveries accounted for 62.2% of all births in Greece—meaning nearly six out of ten women gave birth via surgery. The findings come from a study by demographer Byron Kotzamanis, published in the digital bulletin PopNews of the Institute of Demographic Research and Studies.

A Global Surge in Caesarean Sections

Data from the World Health Organization (WHO) show that caesarean births have more than tripled globally since 1990. The global average rose from 6.7% to 22% in 2023.

The fastest increase has been recorded in lower-income countries, where access to caesarean delivery has helped reduce maternal and neonatal mortality. However, rising rates in high-income countries—where birth-related deaths are already very low—have raised concerns among experts.

What Drives the Increase

According to the study, part of the rise is linked to later maternal age and the increasing number of pregnancies assisted by reproductive technologies. However, researcher Byron Kotzamanis notes that these factors do not fully explain the scale of the increase in developed countries.

In many cases, he argues, caesarean sections are performed without clear medical necessity, despite potential risks for both mother and child. These unnecessary procedures also place additional pressure on healthcare systems.

What Experts Consider ‘Optimal’

International medical consensus suggests that caesarean rates below 10% may indicate insufficient access to essential care, while rates above 20–25% may reflect overuse. Above these thresholds, no further reduction in maternal or infant mortality has been observed.

Excessive use of the procedure is therefore considered a public health concern rather than a medical improvement, according to WHO guidance and international obstetrics organizations.

Greece in Focus

Greece’s situation has been under observation for years. A 2016 World Health Organization Europe office report already highlighted rising caesarean rates in the country as a concern, estimating they exceeded 50% at the time.

Since then, national statistics agency data show a continued upward trend: from 57.8% in 2019 to 62.2% in 2023. This places Greece well above most EU countries.

For comparison, rates in countries such as the Netherlands, Sweden, Slovenia, Estonia, Belgium and France remain below 20%, highlighting a significant gap within Europe.

Not Fully Explained by Demographics

Researchers note that demographic factors alone cannot account for Greece’s high rate. For example, the proportion of women giving birth at age 40 or older is similar in Greece, Spain and Ireland. Yet caesarean rates differ significantly: 62.2% in Greece, compared with 24.7% in Spain and 38.6% in Ireland.

Health System and Policy Concerns

The study warns that excessive caesarean use increases healthcare costs for both families and public health systems, including national insurance providers. More importantly, it raises concerns over patient safety and long-term health outcomes.

Kotzamanis calls for targeted action involving healthcare professionals, expectant mothers and families, alongside awareness campaigns and policy measures. He stresses that cooperation with medical associations is essential to address what he describes as a “caesarean epidemic” in the country.