A new Global Health Action analysis identifies critical inequities in caesarean access and points toward actionable solutions. First, poorest mothers face the highest obstetric risk yet have the lowest surgical access—a reversal of equitable care requiring targeted investment. Second, the analysis confirms that surgical capacity, not clinical demand, limits rates in rural areas; many obstetric emergencies go unaddressed due to missing operating theatres and trained surgeons. Third, practical interventions can narrow this gap: eliminating user fees for emergency caesarean delivery removes financial barriers, while building surgical capacity in underserved regions addresses infrastructure deficits. The study examined data from multiple sub-Saharan countries, establishing that wealthy urban centres achieve adequate rates while poorest rural areas remain critically underserved. Policymakers and health system leaders can leverage these findings to design evidence-based maternal health programmes.
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