The impact of shifts in maternal age to caesarean rates in 17 European countries from 2015-2024
Abstract
Objectives: Over recent decades, caesarean section (CS) rates have steadily increased across Europe, contemporaneous with rising maternal age at birth and consequent shifts in maternal age distributions. Cross-country comparisons rarely disentangle how changing maternal age composition versus age-specific CS rates contributes to temporal trends. This study quantifies maternal age composition’s role in driving CS rate trajectories across European countries.
Methods: We used data from the Euro-Peristat network which compiles perinatal health indicators using a common protocol from routine birth registries, vital statistics, and hospital records in European countries. Data included all births ≥22 weeks’ gestation by mode of delivery (caesarean/vaginal) and stratified by maternal age groups (<25, 25-34, 35-39, ≥40 years) provided by 17 countries from 2015 to 2024. A Kitagawa decomposition was applied to partition the CS rate changes over time into composition effects (changes attributed to maternal age distribution shifts) and rate effects (changes attributed to shifts in age-specific CS rates).
Results: In 2015, rates varied from 16.5 to 56.9% across participating countries, with consistently higher rates for mothers over 35 (20.9 to 61.1%) and over 40 (25.5 to 74.2%) compared to those 25-34 (11.8 to 46.7%). Between 2015 and 2024, trends varied with rate differences from -4.4 to 9.6 percentage points. The decomposition showed that, in every country, shifts in the maternal age distribution produced a modest increase in CS rates of 0.3–1.5 percentage points over the decade. Age-specific rate effects dominated CS rate changes; these were increasing in 11 countries, decreasing in 5, and stable in 1.
Conclusions: An upward pressure on CS rates exerted by maternal age composition across all countries means that efforts to stabilize CS rates must offset this demographic influence. Age-specific CS rates emerged as the main driver of temporal differences in overall CS trends.
Key messages: • This work quantifies an upward pressure on caesarean section rates exerted by maternal age composition, implying efforts to stabilize caesarean section rates must offset this demographic influence.
• This work decomposes overall caesarean section trends in Europe to show that age-specific caesarean section rates are the predominant driver of temporal differences.
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BibTeX
@article{savelli2026impact,
title = {{The impact of shifts in maternal age to caesarean rates in 17 European countries from 2015-2024}},
author = {L Savelli and J Zeitlin and M Philibert},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.970},
url = {https://doi.org/10.1093/eurpub/ckag169.970},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - The impact of shifts in maternal age to caesarean rates in 17 European countries from 2015-2024
AU - L Savelli
AU - J Zeitlin
AU - M Philibert
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.970
UR - https://doi.org/10.1093/eurpub/ckag169.970
AB - Objectives: Over recent decades, caesarean section (CS) rates have steadily increased across Europe, contemporaneous with rising maternal age at birth and consequent shifts in maternal age distributions. Cross-country comparisons rarely disentangle how changing maternal age composition versus age-specific CS rates contributes to temporal trends. This study quantifies maternal age composition’s role in driving CS rate trajectories across European countries. Methods: We used data from the Euro-Peristat network which compiles perinatal health indicators using a common protocol from routine birth registries, vital statistics, and hospital records in European countries. Data included all births ≥22 weeks’ gestation by mode of delivery (caesarean/vaginal) and stratified by maternal age groups (<25, 25-34, 35-39, ≥40 years) provided by 17 countries from 2015 to 2024. A Kitagawa decomposition was applied to partition the CS rate changes over time into composition effects (changes attributed to maternal age distribution shifts) and rate effects (changes attributed to shifts in age-specific CS rates). Results: In 2015, rates varied from 16.5 to 56.9% across participating countries, with consistently higher rates for mothers over 35 (20.9 to 61.1%) and over 40 (25.5 to 74.2%) compared to those 25-34 (11.8 to 46.7%). Between 2015 and 2024, trends varied with rate differences from -4.4 to 9.6 percentage points. The decomposition showed that, in every country, shifts in the maternal age distribution produced a modest increase in CS rates of 0.3–1.5 percentage points over the decade. Age-specific rate effects dominated CS rate changes; these were increasing in 11 countries, decreasing in 5, and stable in 1. Conclusions: An upward pressure on CS rates exerted by maternal age composition across all countries means that efforts to stabilize CS rates must offset this demographic influence. Age-specific CS rates emerged as the main driver of temporal differences in overall CS trends. Key messages: • This work quantifies an upward pressure on caesarean section rates exerted by maternal age composition, implying efforts to stabilize caesarean section rates must offset this demographic influence. • This work decomposes overall caesarean section trends in Europe to show that age-specific caesarean section rates are the predominant driver of temporal differences.
SN - 1101-1262
SN - 1464-360X
ER -