With the surge in cesarean deliveries in Egypt, questions are being raised about the effectiveness of government efforts to curb a phenomenon that reflects a malfunction in the medical system. The rate of mothers who underwent cesarean sections reached around 72% in 2021, placing Egypt at the top of the global list of countries with the highest prevalence of such births.
This leap came despite Egypt recording relatively low rates in 2000 compared to neighboring countries. The percentage rose to 28% in 2008, then doubled to 52% in 2014, ranking Egypt as the third highest globally at that time. By 2021, the figure had reached its peak, according to Dr. Abla El-Alfi, Deputy Minister of Health and Population for Population and Family Development, who described this rise as evidence of shortcomings in medical practices. She called for a review of current policies and for promoting natural childbirth in line with international health standards.
In an attempt to address this crisis, the Ministry of Health and Population issued on August 29 a package of binding regulatory measures for all private medical facilities, aimed at encouraging safe natural childbirth and reducing unnecessary cesarean operations. Dr. Hossam Abdel Ghaffar, the ministry’s official spokesperson, stressed that these measures seek to protect the health of mothers and newborns by applying best medical practices, closely monitoring statistical reports, and improving obstetrics and gynecology services in the private sector. These efforts fall within the framework of the presidential initiative “The Golden 1,000 Days for Egyptian Family Development”, launched in August 2023, which focuses on the health of mothers and children from pregnancy until the child turns two.
In a related context, findings from the Egyptian Family Health Survey, published by the Central Agency for Public Mobilization and Statistics (CAPMAS) in June 2023, revealed that the average rate of cesarean deliveries in Egypt stood at 72% in 2021, putting the country at the top of the global list. Egypt had ranked third in 2014 with a rate of 51.8%. Data shows that cesarean births jumped from 10% in 2000 to 72% in 2021 — a sevenfold increase in just two decades.
Port Said Governorate recorded the highest cesarean rate at 91.3%, followed by Kafr El-Sheikh at 88.4%, and Gharbia at 84.3%. In terms of facility type, private health institutions recorded a cesarean rate of 81%, while public facilities registered only 19%.
The measures announced by the ministry also require private medical facilities to submit detailed monthly statistical reports, including: the total number of births in each facility; the percentage of cesarean deliveries, categorized according to the Robson Classification system — designed to document every birth and determine whether a cesarean section was medically necessary; and an analysis of the reasons for performing cesareans based on data from the partograph tool, a globally recognized instrument used to track the stages of labor. The partograph enables doctors to detect potential challenges early and intervene at the right moment to ensure the safety of both mother and child. The measures also call for recording the challenges faced by medical teams during implementation. These requirements officially came into force at the end of August.
Will Egypt’s New Law Make Cesarean Sections Exclusive to the Wealthy?
Profit Before Safety
Cesarean delivery rates have risen significantly over the past decades worldwide, particularly in Egypt. Although cesarean section is a life-saving surgical procedure in certain cases, its overuse raises medical, ethical, and economic concerns. The Egyptian Women’s Issues Foundation argues that women in Egypt need clear information about their available birthing options, active participation in medical decision-making, and protection from any exploitation or coercion toward surgical interventions without medical necessity. The foundation stressed that women’s bodies should not serve as arenas for rushed decisions or financial gain, emphasizing that the right to safe natural childbirth is an essential part of the right to health and bodily autonomy.
From an economic perspective, the dramatic increase in cesarean rates represents an enormous burden on the state budget. Official statistics issued in 2018 estimated the annual cost at about 120 billion pounds ($2.4 billion). At the same time, recent years have seen a sharp rise in cesarean prices: in public hospitals, the cost now ranges between 3,000 and 6,000 pounds ($63 to $120), even though these hospitals once provided the service free of charge. In private clinics and centers, prices have surged to between 15,000 and 30,000 pounds ($300 to $600).
In 2023, the Ministry of Health and Population announced a significant reduction in unnecessary cesarean deliveries in government hospitals under its supervision, reporting a rate of 61% during January and February of that year. Rates also dropped in Kafr El-Sheikh Governorate to 78.7% after reaching 88.4% in 2021, and in Gharbia from 84.3% to 72.3%. The ministry warned that unnecessary cesareans expose mothers to serious risks such as placenta accreta, hysterectomy, and severe hemorrhage during childbirth. They may also harm children, increasing the likelihood of intestinal infections, obesity, allergies, autism, diabetes, and immune disorders later in life.
Risks of Childbirth and the Imprisonment of Doctors
While many welcomed the measures announced by the Ministry of Health, a large segment of obstetricians and gynecologists in Egypt expressed concerns over shortages of resources and medical supplies in hospitals and health centers, alongside what they described as the “risks” associated with natural childbirth — risks that could result in a doctor’s imprisonment in cases of complications or the death of the mother or infant.
Although natural childbirth is medically considered the best option for the mother’s health and is less costly, it carries higher risks compared to cesarean delivery, particularly for the infant. Doctors attribute this to the prolonged duration of labor, which can lead to reduced oxygen supply to the fetus, or the need for emergency medical intervention, which in some cases requires switching to a cesarean section. This, according to Dr. Khaled El-Satouhi, professor of obstetrics and gynecology at Qasr Al-Aini Faculty of Medicine and consultant in fetal medicine and laparoscopic surgery.
El-Satouhi explains that current laws impose heavy responsibilities on doctors, including possible imprisonment, even if they adhere strictly to medical protocols — a reality that drives many to prefer cesarean delivery as a precaution. He added that doctors are often subjected to verbal or physical assaults from patients’ families, as well as financial pressures that may involve demands for large sums of money in exchange for dropping lawsuits.
Speaking to Zawia3, he said: “The lack of equipment, such as fetal heart monitors, increases risks and makes doctors more cautious about resorting to natural childbirth. Even informed consent signed by patients carries no legal weight, as it is considered a form of coercion, leaving doctors in constant danger of imprisonment or financial extortion.”
He continued: “Sometimes we spend more than a full day with a patient during natural childbirth, which requires continuous monitoring of the fetus’s condition, heartbeat, and the progress of labor, in anticipation of complications such as fetal asphyxia.” He pointed out that societal culture poses an additional challenge, as many see prolonged labor as unnecessary suffering and pressure doctors to perform a cesarean earlier — amplifying the psychological and social burden on physicians.
Despite his support for the ministry’s measures encouraging natural childbirth, El-Satouhi believes that reducing unnecessary cesareans must begin with reforming laws, particularly by abolishing imprisonment penalties for medical complications arising during natural deliveries. He also called for awareness campaigns on the importance of natural childbirth and investment in training nursing staff and midwives to support doctors.
The Medical Liability and Patient Safety Law No. 13 of 2025 stipulates imprisonment for medical errors in certain cases: gross negligence, clear carelessness, errors leading to permanent disability, committing mistakes under the influence of alcohol or drugs, or refusal by the healthcare provider to assist the patient when the error occurs. The law states that penalties may include imprisonment of up to two years and/or a fine not exceeding 300,000 pounds ($6,000).
Shortage of Safe Natural Childbirth Facilities
Dr. Maria Armia, obstetrics, gynecology, and infertility specialist, believes that the rise in cesarean deliveries in Egypt is due to a combination of interlinked factors involving the patient, the doctor, and the healthcare system itself. She noted that a large number of women prefer cesareans to avoid the pain of natural childbirth, or because of past traumatic experiences with prolonged labor, or the loss of a relative during natural delivery — fears that reinforce psychological apprehensions.
Speaking to Zawia3, she said: “Painless natural childbirth using epidural anesthesia is not widely available, and in some governorates it can actually be more expensive than cesarean deliveries. There is also a shortage of labor-inducing drugs, and most hospitals in Egypt — particularly in Upper Egypt — lack fetal heart monitoring devices needed for childbirth, including government hospitals.”
The doctor emphasized that working conditions for physicians in Egypt do not provide adequate support compared to abroad. Doctors are forced to accompany patients for long hours without extra compensation, amid the absence of supportive medical staff such as trained midwives, making it harder to monitor natural labor. This situation, she argued, pushes some physicians to prefer cesareans, which are performed at fixed times and with less effort.
Armia also pointed out that the Medical Liability Law has become another source of pressure on doctors, as they fear legal prosecution if complications arise, even when following correct medical procedures. This risk is heightened by the shortage of fetal monitoring devices in most hospitals, making natural childbirth even more dangerous. She stressed that ensuring safe natural childbirth is often more complex and costly than performing cesareans.
According to Armia, there are major obstacles to implementing the Ministry of Health’s statement on reducing cesarean rates. Chief among them are the lack of labor-inducing drugs, which have been unavailable for years, limited resources in governorates — especially in Upper Egypt — and the absence of genuine societal awareness of the importance of natural childbirth. She asserted that any plan to reduce cesarean deliveries will fail unless basic supplies and equipment are provided, alongside legislation that protects doctors.
In 2023, the Minister of Health instructed that doctors and medical teams should receive equal compensation for natural deliveries as for cesareans, and that financial incentives be allocated to teams achieving higher natural delivery rates. The minister also called for surveys and studies in residential areas to collect data that would help improve ways of encouraging pregnant women to choose natural delivery, as well as community discussions on the risks of cesareans and more psychological counseling sessions for women.
The minister further urged the drafting of legislation guaranteeing doctors, midwives, and nurses the right to practice natural delivery even in cases of minor side effects, the introduction and support of midwifery as a medical specialty, the organization of regular training for medical teams, and the expansion of midwife training. He also directed the collection of routine health data on cesarean deliveries and their causes, and required all private and public hospitals to adhere to clinical guidelines governing the conditions and criteria for resorting to cesareans.
Activating Medical Liability Committees
Dr. Khaled Amin, Assistant Secretary-General of the Doctors’ Syndicate, considers the package of measures announced by the Ministry of Health to reduce unnecessary cesarean deliveries feasible and capable of producing positive results. However, he stressed in a statement to Zawia3 that these measures require additional support to broaden their effectiveness.
Amin believes one of the main challenges is that health authorities focus solely on service providers without giving sufficient attention to educating women and families. He explained that many women opt for cesarean delivery due to misconceptions — primarily fear of pain or anxiety about the impact of natural childbirth on marital relations. This, he argued, necessitates broad awareness campaigns to correct such misconceptions, particularly through promoting painless delivery methods.
He added that the high cost of epidural catheters and their limited availability represent obstacles for many women, urging the state to make them available at affordable prices, as it once did with family planning methods. Amin further pointed out that the first childbirth experience heavily influences women’s decisions in subsequent deliveries, making it essential to involve specialized medical committees in decisions on cesarean sections instead of leaving the matter solely to the attending physician.
He also called for reinstating the role of trained midwives in hospitals to reduce pressure on doctors and support women during natural labor, in addition to activating medical liability committees to protect both doctors and patients, particularly in cases where complications during natural delivery force the physician to resort to a cesarean to avoid legal liability.
Amin highlighted the importance of providing essential equipment such as fetal heart monitors in sufficient numbers, expanding the establishment of safe birthing centers within government, university, and private hospitals, and standardizing medical protocols across obstetrics and gynecology departments.
The World Health Organization recommends that cesarean delivery rates should not exceed 10 to 15% of all births to ensure the best health outcomes for both mother and child.
Legislation to Curb Excessive Cesareans
MP Dr. Ashraf Hatem, head of the Health Committee in Parliament, affirmed that the Medical Liability Law does not stipulate imprisonment as some doctors believe, but rather limits penalties to fines in cases where medical error is proven, without imposing custodial sentences.
In a statement to Zawia3, he pointed out that the cesarean delivery rate in Egypt — around 70%, especially in the private sector — is among the highest globally, compared to averages ranging between 20% and 30% in most countries, describing the phenomenon as unprecedented.
He explained that natural childbirth is a safe physiological process, with fewer risks for both mother and infant compared to cesareans. However, the inability to precisely determine its timing drives some doctors and women to prefer cesarean delivery for being quicker and more convenient, despite its greater complications.
Hatem stressed that natural childbirth in public, central, and university hospitals should be completely free of charge or covered by the state, while cesarean delivery should remain a paid service except when medically necessary. He argued that this economic incentive could be a key factor in encouraging women to opt for natural delivery. He noted that the Health Committee had discussed these proposals during the previous parliamentary session and recommended their implementation, along with intensifying awareness campaigns on the benefits of natural childbirth compared to cesareans.
For his part, Dr. Alaa Ghannam, head of the Right to Health Committee at the Egyptian Initiative for Personal Rights, believes that reducing unnecessary cesarean deliveries requires strict governance of both the public and private sectors, the application of service quality standards, and the accreditation of medical centers, with strict adherence to clinical guidelines in obstetrics and gynecology.
He emphasized that the success of these policies depends on effective implementation mechanisms and rigorous oversight tools, not merely their existence on paper.
Speaking to Zawia3, Ghannam explained that strengthening primary healthcare and expanding the universal health insurance system are key tools to reduce the commodification of medical services and promote natural childbirth over unnecessary cesareans. He highlighted the importance of regular prenatal care and encouraging breastfeeding as integral parts of this system, stressing that natural delivery should be the primary option, with cesareans reserved for exceptional cases.
Despite the measures announced by the Ministry of Health to reduce unnecessary cesarean deliveries, their success remains contingent upon providing the supplies and equipment needed for safe natural childbirth in both public and private hospitals, at affordable costs, alongside health education for families and legal safeguards that protect doctors from imprisonment. With Egypt continuing to top global cesarean delivery rates, the Ministry of Health’s ability to make natural childbirth the first choice for both mothers and physicians remains the greatest challenge.
