Rwanda’s Caesarean section rate has risen to 24%, according to the latest Rwanda Demographic and Health Survey (RDHS7), prompting renewed debate about what is driving the growing number of surgical births across the country.
A Caesarean section, commonly known as a C-section, can be a life-saving procedure when medically necessary.
It can help prevent serious complications during childbirth, including prolonged or obstructed labour, and can protect both mothers and newborns when vaginal delivery becomes unsafe.
However, the continued increase in C-section deliveries has raised questions about whether the growing rate is being driven primarily by medical needs or whether other factors are contributing to the trend.
The current 24% rate is more than twice the 10% level referenced by the World Health Organization (WHO).
In its guidance on Caesarean sections, WHO noted that at population level, C-section rates above 10% are not associated with reductions in maternal and newborn mortality rates.
The organisation, however, does not recommend using 10% as a target or limit for individual women, because some pregnancies require Caesarean delivery to save lives.
Rwanda’s C-section rate has increased significantly over the past two decades. Research based on the 2019–20 DHS showed that the rate had risen from just 2.2% in 2000 to 15.6% in 2019–20.
The latest RDHS7 figure of 24% represents a further substantial increase.
The rise comes as Rwanda continues to make progress in reducing maternal deaths.
The latest DHS data show that the country’s maternal mortality ratio declined from 203 deaths per 100,000 live births in 2020 to 149 deaths per 100,000 live births in 2025.
The relationship between these two trends, however, is complex. The increase in Caesarean deliveries cannot by itself explain the decline in maternal mortality, which is influenced by several factors, including access to skilled birth attendants, antenatal care, emergency obstetric services, timely referrals, blood transfusion and the overall quality of maternal healthcare.
Previous studies have also pointed to significant differences in C-section rates depending on where women give birth.
Data from the 2019–20 DHS, for example, showed a Caesarean rate of 60.6% in private health facilities compared with 15.4% in public facilities.
Health experts generally emphasise that the priority should not simply be to reduce the number of Caesarean deliveries, but to ensure that the procedure is available whenever it is medically required while avoiding unnecessary surgery.
For Rwanda, the growing rate therefore raises an important public health question: What is really driving the increase in C-sections—from medical complications and improved access to emergency care to patterns of care in different health facilities?
As the country continues to strengthen maternal and newborn healthcare, understanding the reasons behind the rise will be critical to ensuring that Caesarean sections remain a life-saving intervention while women are protected from unnecessary surgical procedures.
