The cesarean section rate in France stood at 21.4% of births in 2021, according to the National Perinatal Survey conducted by Santé publique France and Inserm. This figure has been stable since 2010, while the global rate continues to rise. Here is what the official data measure, what leads to a cesarean section, the World Health Organization's position, and what these figures concretely mean for parents preparing for a birth.
What is the cesarean section rate in France today?
In 2021, 21.4% of women who gave birth in metropolitan France did so by cesarean section. The figure was 20.3% in 2016. The National Perinatal Survey, whose results were published on October 6, 2022, describes this rate as stable since 2010. Just over one in five births therefore ends in the operating room, and this proportion has not changed significantly in ten years.
This survey is the reference source on the subject. It is conducted approximately every five years, over one week, among all women giving birth in France. The 2021 edition included 12,723 women in metropolitan France, representing 12,939 births, across 456 maternity units and 6 birth centers.
What the National Perinatal Survey measures regarding cesarean sections
The cesarean section rate should not be considered on its own. The survey also records several indicators that describe how women give birth in France:
- Induction of labor increased: 25.8% of births in 2021, compared with 22.0% in 2016.
- Epidural analgesia concerns 82.7% of women.
- Instrumental vaginal births (forceps, vacuum extraction) remain stable, at around 12%.
- Episiotomies have declined sharply: 8.3% in 2021, compared with 20.1% in 2016.
- Midwives conduct 88.6% of spontaneous vaginal births.
The overall picture is of obstetric care that intervenes differently: fewer episiotomies, more inductions, and no increase in the use of cesarean sections.
Why has the cesarean section rate remained stable in France?
The survey identifies the main risk factor: having previously given birth by cesarean section. A first cesarean section significantly increases the likelihood of a second one, which maintains the rate from one generation of births to the next. This mechanism explains why French recommendations focus primarily on preventing the first cesarean section and on the possibility of a vaginal birth after a previous cesarean.
In 2012, the Haute Autorité de santé published recommendations on the indications for planned cesarean section at term. In particular, they state that a scarred uterus is not, on its own, an indication for a planned cesarean section, and that breech presentation or a twin pregnancy does not systematically require one. The decision is made on a case-by-case basis after the woman has been informed.
Other factors affect the rate, although the survey cannot isolate them. Mothers are older: 19.2% of women giving birth were between 35 and 39 years old in 2021, compared with 17.2% in 2016, and 5.4% were aged 40 or over, compared with 3.9%. Overweight affected 23.0% of pregnant women and obesity 14.4%, with both indicators increasing. These trends would tend to increase cesarean section rates, making the stability observed all the more notable.
How does France compare with the rest of the world?
According to the World Health Organization, cesarean sections accounted for 21% of births worldwide in 2018, a figure that continues to rise. The WHO projects that 29% of births will be by cesarean section in 2030 if the trend continues. Regional differences are considerable: 25.7% in Europe, 42.8% in Latin America and the Caribbean, and 5.0% in sub-Saharan Africa.
France is therefore below the European average and close to the 2018 global average. The two extremes described by the WHO coexist: an excess of medically unjustified cesarean sections in some parts of the world, and insufficient access to the procedure where it would save lives.
Is there a “right” cesarean section rate?
Since 1985, the international medical community had long adopted an ideal range of 10% to 15%. In a statement published on April 9, 2015, the WHO qualified this target. It observed that, at the population level, maternal and neonatal mortality decreases as the cesarean section rate approaches 10%, but that beyond this threshold there is no evidence that mortality improves further.
The WHO no longer recommends aiming for a specific figure. It calls for every cesarean section to respond to a medical need, and for facilities to use the Robson classification to compare their practices consistently. This classification divides women into ten groups according to parity, gestational age, fetal presentation, and how labor begins. It makes it possible to identify which group is seeing an increase in cesarean sections, rather than comparing overall rates that combine different situations.
What these figures mean for parents
A probability to be aware of, not a certainty
One in five women will give birth by cesarean section, often without having planned it. Knowing that the procedure is common, carefully managed, and most often decided during labor can help parents consider it without dramatizing it. Childbirth preparation classes generally cover cesarean sections. It is reasonable to ask the maternity unit about its practices, particularly regarding the presence of a support person and contact with the baby.
A slightly different hospital bag and return home
After a cesarean section, the hospital stay is generally longer than the average, which was 3.7 days in 2021 across all delivery methods. The incision limits carrying heavy loads and certain movements for several weeks. Packing clothes without a tight waistband and arranging help at home in advance can make a real difference. Our article on what to pack in your maternity bag explains what is genuinely useful, while our article on going out with a newborn for the first time helps you resume a routine without overdoing it.
Preparing for a second pregnancy
Since a previous cesarean section is the main risk factor for another cesarean, the question of vaginal birth after cesarean arises as early as the next pregnancy. It should be discussed with the obstetric team, depending on the reason for the first procedure, the interval between pregnancies, and how the current pregnancy is progressing.
Other survey indicators that directly concern parents
The 2021 National Perinatal Survey provides other useful reference points, which we have covered in dedicated articles. The preterm birth rate is stable at 7.0%, a subject explored in our article on preterm birth in France. Postpartum depression affects 16.7% of women at two months, as discussed in our article on the baby blues and postpartum depression. Breastfeeding, smoking during pregnancy, and flu vaccination are also measured, and our article on breastfeeding in France covers these data. Finally, the number of maternity units fell by 8% between 2016 and 2021, a trend to consider alongside the figures on birth rates in France.
In summary
The cesarean section rate in France is 21.4%, stable for ten years, below the European average of 25.7% and far below the 42.8% observed in Latin America. The main risk factor is a previous cesarean section. The WHO no longer sets a target rate and calls for every procedure to be medically justified. For parents, these figures are an invitation to prepare for birth while taking this possibility into account, without fearing it or considering it inevitable.
Sources
- Santé publique France, Inserm: National Perinatal Survey, results of the 2021 edition, press release of October 6, 2022, and report “Births, follow-up at two months, and facilities.”
- World Health Organization: “Caesarean section rates continue to rise, amid growing inequalities in access,” June 16, 2021.
- World Health Organization: “WHO Statement on Caesarean Section Rates,” April 9, 2015.
- Haute Autorité de santé: “Indications for Planned Cesarean Section at Term,” good practice recommendation, January 2012.
