Caesarean sections can be a lifesaving procedure for mother and baby, but rates beyond 10% of live births are not associated with reductions in maternal and newborn mortality. Caesarean section rates at national level vary between around 2% in Chad, Burkina Faso, Ethiopia or Madagascar and above 50% in Brazil, Dominican Republic or Egypt. The trend towards overuse of caesarean sections is a major concern globally, given the risks to the mother and her child associated with unnecessary caesarean birth. These risks include avoidable maternal complications such as infections, haemorrhage, complications related to use of anaesthesia or blood transfusion, and infant morbidity, for example, respiratory problems, asthma and obesity in children. Caesarean sections can also lead to added complications for the mother in subsequent pregnancies, including uterine rupture, placental implantation problems and need for hysterectomy. High rates of caesarean sections are also associated with substantial health-care costs, which can pose a considerable burden on health systems. Multiple factors are driving increases in caesarean section rates. Clinical reasons for growing rates include increases in the incidence of maternal obesity, multiple pregnancies and a higher maternal age at birth. These factors alone are unlikely to explain the extent of the rise in caesarean section rates or the substantial variations among health-care providers, hospitals and regions. Studies have shown associations between caesarean section rates and non-clinical factors such as differences in health provider practices, fear of malpractice litigation and organizational, economic, social and cultural factors. A growing proportion of caesarean sections globally are not medically indicated and could have been avoided. To address the rising rates worldwide and prevent the harm to women and newborns resulting from overuse of this procedure, in 2018 the World Health Organization (WHO) published new recommendations on non-clinical interventions to reduce unnecessary caesarean sections. In this guideline, non-clinical interventions are defined as those interventions that are applied outside of the routine clinical interactions between a provider and pregnant woman. The interventions may target women (for instance, birth preparation classes), health-care providers (clinical practice guidelines) or health organizations (different payment systems for caesarean sections). The recommendations, are grouped according to the target of interventions and address major determinants of caesarean section rates. The recommendations are intended to inform the development of national and subnational policies and protocols to reduce unnecessary caesarean births in high-, middle- and low-income countries. The new recommendations should be integrated and implemented with other related WHO guidelines, such as WHO recommendations on antenatal and intrapartum care for a positive childbirth experience.