{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T02:51:39Z","timestamp":1780368699341,"version":"3.54.1"},"reference-count":74,"publisher":"The Royal Society","issue":"1896","license":[{"start":{"date-parts":[[2019,2,6]],"date-time":"2019-02-06T00:00:00Z","timestamp":1549411200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/royalsociety.org\/journals\/ethics-policies\/data-sharing-mining\/"}],"funder":[{"name":"Austrian Science Fund","award":["P29397"],"award-info":[{"award-number":["P29397"]}]}],"content-domain":{"domain":["royalsocietypublishing.org"],"crossmark-restriction":true},"short-container-title":["Proc. R. Soc. B."],"published-print":{"date-parts":[[2019,2,13]]},"abstract":"<jats:p>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\u2014via its influence on pre- and postnatal growth\u2014the 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 \u2018ideal' C-section rate.<\/jats:p>","DOI":"10.1098\/rspb.2018.2425","type":"journal-article","created":{"date-parts":[[2019,2,6]],"date-time":"2019-02-06T08:05:39Z","timestamp":1549440339000},"page":"20182425","update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Secular changes in body height predict global rates of caesarean section"],"prefix":"10.1098","volume":"286","author":[{"given":"Eva","family":"Zaffarini","sequence":"first","affiliation":[{"name":"Department of Theoretical Biology, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria"},{"name":"Department of Biotechnology and Bioscience, University of Milano-Bicocca, Piazza della Scienza 2, 20126 Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5308-3837","authenticated-orcid":true,"given":"Philipp","family":"Mitteroecker","sequence":"additional","affiliation":[{"name":"Department of Theoretical Biology, University of Vienna, Althanstrasse 14, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"175","published-online":{"date-parts":[[2019,2,6]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/evan.1360040506"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.22160"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2014.0065"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1612410113"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2003.302"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-3156.1996.d01-83.x"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1038\/sj.ijo.0801670"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.06.057"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2003.09.058"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2004.09.013"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2005.10.016"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1701-2163(15)30228-0"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2018.00292"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13526"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148343"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13284"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198907273210406"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-536X.2001.00101.x"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(03)00217-0"},{"key":"e_1_3_6_22_2","first-page":"48","article-title":"Are there socio-economic differences in caesarean section rates in Canada?","volume":"1","author":"Leeb K","year":"2005","journal-title":"Heal Policy"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k55"},{"key":"e_1_3_6_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/emph\/eoy006"},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.13.117598"},{"key":"e_1_3_6_26_2","first-page":"e260-70","article-title":"Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys","volume":"3","author":"Vogel J","year":"2015","journal-title":"Lancet"},{"key":"e_1_3_6_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2008.06.032"},{"key":"e_1_3_6_28_2","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.11.090399"},{"key":"e_1_3_6_29_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7028.410"},{"key":"e_1_3_6_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0378-3782(02)00075-0"},{"key":"e_1_3_6_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/79.1.17"},{"key":"e_1_3_6_32_2","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2002.128029"},{"key":"e_1_3_6_33_2","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.12027"},{"key":"e_1_3_6_34_2","doi-asserted-by":"publisher","DOI":"10.1177\/014107689108400505"},{"key":"e_1_3_6_35_2","doi-asserted-by":"publisher","DOI":"10.1053\/sper.2002.34772"},{"key":"e_1_3_6_36_2","doi-asserted-by":"publisher","DOI":"10.1080\/j.1600-0412.2000.079006440.x"},{"key":"e_1_3_6_37_2","doi-asserted-by":"publisher","DOI":"10.1159\/000342576"},{"key":"e_1_3_6_38_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0021932016000316"},{"key":"e_1_3_6_39_2","doi-asserted-by":"publisher","DOI":"10.1159\/000184841"},{"key":"e_1_3_6_40_2","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.13410"},{"key":"e_1_3_6_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1570-677X(02)00033-3"},{"key":"e_1_3_6_42_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0021932003002633"},{"key":"e_1_3_6_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/0168-9525(91)90230-N"},{"key":"e_1_3_6_44_2","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2014.0067"},{"key":"e_1_3_6_45_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e3181cbd5f5"},{"key":"e_1_3_6_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2011.11.002"},{"key":"e_1_3_6_47_2","doi-asserted-by":"publisher","DOI":"10.1016\/0028-2243(81)90080-0"},{"key":"e_1_3_6_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0271-5317(82)80034-1"},{"key":"e_1_3_6_49_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2008.01694.x"},{"key":"e_1_3_6_50_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1205282109"},{"key":"e_1_3_6_51_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1520-6661(199709\/10)6:5<276::AID-MFM7>3.0.CO;2-D"},{"key":"e_1_3_6_52_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-27"},{"key":"e_1_3_6_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2008.03.007"},{"key":"e_1_3_6_54_2","unstructured":"Jahan S. 2016 Human Development Report 2016: human development for everyone. New York NY: UNDP."},{"key":"e_1_3_6_55_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30818-8"},{"key":"e_1_3_6_56_2","unstructured":"Xu et al. 2018 New perspectives on global health spending for universal health coverage . Geneva Switzerland: World Health Organization."},{"key":"e_1_3_6_57_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4757-3235-1"},{"key":"e_1_3_6_58_2","volume-title":"Causality","author":"Pearl P","year":"2000"},{"key":"e_1_3_6_59_2","volume-title":"Structural equation modeling","author":"Bowen KB","year":"2012"},{"key":"e_1_3_6_60_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v048.i02"},{"key":"e_1_3_6_61_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1467-6419.2010.00639.x"},{"key":"e_1_3_6_62_2","volume-title":"Encounters with aging: mythologies of menopause in Japan and North America","author":"Lock M","year":"1993"},{"key":"e_1_3_6_63_2","doi-asserted-by":"publisher","DOI":"10.1080\/01459740.2013.791290"},{"key":"e_1_3_6_64_2","doi-asserted-by":"publisher","DOI":"10.1002\/ar.23540"},{"key":"e_1_3_6_65_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a009881"},{"key":"e_1_3_6_66_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajpa.10137"},{"key":"e_1_3_6_67_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.ede.0000152524.89074.bf"},{"key":"e_1_3_6_68_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwk107"},{"key":"e_1_3_6_69_2","doi-asserted-by":"publisher","DOI":"10.1086\/418300"},{"key":"e_1_3_6_70_2","doi-asserted-by":"publisher","DOI":"10.1002\/ar.23542"},{"key":"e_1_3_6_71_2","doi-asserted-by":"publisher","DOI":"10.1080\/09751270.2009.11885142"},{"key":"e_1_3_6_72_2","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1515\/9783110815603.167","volume-title":"Population, ecology, and social evolution","author":"Angel JL","year":"1975"},{"key":"e_1_3_6_73_2","doi-asserted-by":"publisher","DOI":"10.1002\/9780470670170"},{"key":"e_1_3_6_74_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1712203114"},{"key":"e_1_3_6_75_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41559-018-0773-2"}],"container-title":["Proceedings of the Royal Society B: Biological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/royalsocietypublishing.org\/doi\/pdf\/10.1098\/rspb.2018.2425","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/royalsocietypublishing.org\/doi\/full-xml\/10.1098\/rspb.2018.2425","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/royalsocietypublishing.org\/doi\/pdf\/10.1098\/rspb.2018.2425","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,11]],"date-time":"2022-09-11T12:48:09Z","timestamp":1662900489000},"score":1,"resource":{"primary":{"URL":"https:\/\/royalsocietypublishing.org\/doi\/10.1098\/rspb.2018.2425"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,6]]},"references-count":74,"journal-issue":{"issue":"1896","published-print":{"date-parts":[[2019,2,13]]}},"alternative-id":["10.1098\/rspb.2018.2425"],"URL":"https:\/\/doi.org\/10.1098\/rspb.2018.2425","relation":{},"ISSN":["0962-8452","1471-2954"],"issn-type":[{"value":"0962-8452","type":"print"},{"value":"1471-2954","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,2,6]]},"assertion":[{"value":"2018-10-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-02-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}