ArticleProceedings. Biological sciences2019
Secular changes in body height predict global rates of caesarean section.
Article in Proceedings. Biological sciences, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
11 citing papers in PubMed.
- Humans are not unique: difficult birth is common in placental mammals.Biological reviews of the Cambridge Philosophical Society · 2026Review
- Associated Factors for Cesarean Section in Pregnant Women with Gestational Diabetes Mellitus.International journal of women's health · 2026Article
- Obstructed Labor, Evolution, and Health Disparities.Biology · 2024Review
- Patterns of Labour Interventions and Associated Maternal Biopsychosocial Factors in Australia: a Path Analysis.Reproductive sciences (Thousand Oaks, Calif.) · 2023Article
- There is an obstetrical dilemma: Misconceptions about the evolution of human childbirth and pelvic form.American journal of biological anthropology · 2023Review
- Quantum Leaps in Human Biocultural Evolution and the Relationship to Cranial Capacity.Life (Basel, Switzerland) · 2023Article
- The evolution of pelvic canal shape and rotational birth in humans.BMC biology · 2021Article
- The obstetrical dilemma hypothesis: there's life in the old dog yet.Biological reviews of the Cambridge Philosophical Society · 2021Article
- Article
- Evolution of the human pelvis and obstructed labor: new explanations of an old obstetrical dilemma.American journal of obstetrics and gynecology · 2020Review
- Caesarean section delivery and childhood obesity in a British longitudinal cohort study.PloS one · 2019Article
Corrections and comments
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Authors and funding
2 authors.
Funding
Abstract
The massive global variation in caesarean-section (C-section) rate is usually attributed to socio-economic, medical and cultural heterogeneity. Here, we show that a third of the global variance in current national C-section rate can be explained by the trends of adult body height from the 1970s to the 1990s. In many countries, living conditions have continually improved during the last century, which has led to an increase in both fetal and adult average body size. As the fetus is one generation ahead of the mother, the fetus is likely to experience better environmental conditions during development than the mother did, causing a disproportionately large fetus and an increased risk of obstructed labour. A structural equation model revealed that socio-economic development and access to healthcare affect C-section rate via multiple causal pathways, but the strongest direct effect on C-section rate was body height change. These results indicate that the historical trajectory of socio-economic development affects-via its influence on pre- and postnatal growth-the intergenerational relationship between maternal and fetal dimensions and thus the difficulty of labour. This sheds new light on historic and prehistoric transitions of childbirth and questions the World Health Organization (WHO) suggestion for a global 'ideal' C-section rate.
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Registered trials
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