OBJECTIVES : Rapidly increasing tendency of caesarean section and its geographical inequality, as well as patient safety and quality of care related to it is a highly debated topic within health care. The aim of this study is to compare the caesarean section rates and its geographical inequalities between countries inside and outside of the European Union.

METHODS : Data were derived from the Health for All database of the World Health Organization (WHO). We selected indicator „HFA_596 Caesarean sections per 1000 live births” from WHO’s Health for All database to analyse the time period between 1990-2014. We compared 28 member states of the European Union with countries outside of the EU. Independent samples T-test or Mann-Whitney test were used for data from years 1990, 1995, 2000, 2005, 2010, 2014. Among European Union countries data for Greece, Portugal and Slovakia were not available in the database.

RESULTS : Average number of caesarean sections per 1,000 live births was 58.2 in the WHO European Region in 1990. This was 85.8 in EU and 39.8 in non-EU countries. Average number of caesarean sections per 1,000 live births was 238.1 in the WHO European Region in 2014. This was 258.4 in EU and 215.8 in non-EU countries. The average of caesarean delivery rate in the WHO European Region increased by +309%. We found a +201% increase in EU 28 group and a +442% growth in non-EU countries between 1990 and 2014. There are significant differences between EU 28 group and non-EU countries in all years except for 2014 (p<0.001; p<0.001; p<0.001; p<0.001; p=0.038; p=0.149). The greatest difference between average rate of EU 28 and non-Eu countries was found in 2005 (213.4; 123.7).

CONCLUSIONS : Caesarean delivery rate per 1,000 live births showed an increasing trend in both EU 28 and in non-EU countries.