Greece records the highest number of caesarean births per 100 deliveries in the European Union, according to new research findings.
Caesarean births have increased globally over recent decades. Data from the World Health Organization show that the number of caesarean deliveries per 100 births more than tripled between 1990 and 2023, rising from 6.7% to 22%. Most of this increase occurred in less developed countries, where maternal and perinatal mortality remains high and the use of caesarean sections contributes to reducing these rates.
However, the rise in caesarean births in developed countries, particularly within the European Union, has raised concern, as mortality rates during childbirth have remained extremely low for decades.
The findings come from research conducted by Viron Kotzamanis, emeritus professor of demography at the University of Thessaly and director of the Institute of Demographic Research and Studies. The study was published in the latest issue of the institute’s digital bulletin PopNews.
Kotzamanis reported that the increase in caesarean sections is only partly explained by factors such as rising maternal age and multiple births resulting from assisted reproduction. In developed countries, he noted, the rise is not linked to improvements in maternal or neonatal mortality. A significant proportion of these procedures is therefore not attributed to medical necessity.
From this perspective, excessive caesarean sections are considered unnecessary, pose risks according to international medical associations, and place an unjustified burden on healthcare systems. For this reason, they have increasingly concerned both the World Health Organization and the International Federation of Gynecology and Obstetrics over the past two decades, prompting calls for measures to limit their overuse.
Regarding the medically optimal rate of caesarean births, the international scientific community generally agrees that rates below 10% or above 20–25% indicate potential public health issues—either insufficient care or unjustified use. Such procedures do not reduce maternal or neonatal mortality beyond certain thresholds and carry additional risks.
In Greece, strong indications of a sharp increase in caesarean sections led the WHO Regional Office for Europe to examine the issue in early 2016, within the framework of its cooperation with the Greek Ministry of Health under the “Strengthening Universal Coverage and Access to Health in Greece” programme.
An expert report submitted that year highlighted the need for measures to curb the rising trend, which at the time already exceeded 50% of births. The report also included comparative cost data and outlined both the factors driving excessive use and policy proposals to address it.
Three years after the report’s publication, the Hellenic Statistical Authority began releasing annual birth distribution data. These figures showed a continued increase, with caesarean births rising from 57.8% in 2019 to 62.2% in 2023, placing Greece first among EU member states.
According to Kotzamanis, Greece’s 2023 rate is more than three times higher than in countries such as the Netherlands, Sweden, Slovenia, Estonia, Belgium, and France, where caesarean births do not exceed 200 per 1,000 deliveries. He emphasised that these levels are particularly high given that Greece does not significantly differ from other countries in terms of maternal age, assisted reproduction rates, or births among women aged 40 and over.
In 2023, Greece recorded 62.2 caesarean births per 100 deliveries, compared with 24.7 in Spain and 38.6 in Ireland.
Speaking to the Athens-Macedonian News Agency, Kotzamanis stressed that these exceptionally high rates increase the cost of childbirth for both families and public healthcare providers, including EOPYY. Beyond financial implications, he warned that excessive caesarean sections constitute a public health issue and underline the urgent need for targeted interventions.
He called for immediate measures to significantly reduce unnecessary procedures, including initiatives targeting healthcare professionals, women, and families. He also emphasised the need for a broad public awareness campaign and the active involvement of medical associations, noting that without their participation, the issue cannot be effectively addressed.
