Objective: To determine the impact of caesarean section on fertility among women in sub-Saharan Africa. Design: Analysis of standardised cross-sectional surveys (Demographic and Health Surveys). Setting: Twenty-two countries in sub-Saharan Africa, 1993-2003. Sample: A total of 35,398 women of childbearing age (15-49 years). Methods: Time to subsequent pregnancy was compared by mode of delivery using Cox proportional hazards regression models. Main outcome measures: Natural fertility rates subsequent to delivery by caesarean section compared with natural fertility rates subsequent to vaginal delivery. Results: The natural fertility rate subsequent to delivery by caesarean section was 17% lower than the natural fertility rate subsequent to vaginal delivery (hazard ratio = 0.83, 95% CI 0.73-0.96, P
BJOG: An International Journal of Obstetrics and Gynaecology (2006) 113 (3) 276-283 [doi:10.1111/j.1471-0528.2006.00846.x]
Caesarean section and subsequent fertility in sub-Saharan Africa.