New data published in a three-part series in The Lancet on optimizing cesarean section use was published last month, and the stats on c-section rates worldwide are staggering. The collection of studies was presented at The International Federation of Gynecology and Obstetrics World Congress in Brazil, one of a handful of countries where over half of all babies are delivered by c-section. The research shows that the global rate of cesareans has nearly doubled since the year 2000, when 12% of babies around the world we born via the surgical procedure. Today 21% of births worldwide are c-sections, even though it’s estimated that only 10-15% are necessary for serious medical complications.

There is no doubt that cesarean delivery is absolutely essential in certain cases in order to keep both mother and baby safe. However, the figures researchers have been collecting since 2015 show that over tw0-thirds of the 169 counties included in the report overuse the surgery without significant maternal or perinatal benefits. The five countries with the highest rates of c-section births have more babies born via surgery versus vaginally, with the Dominic Republic topping the list with 58% of births being cesareans. Brazil, Turkey, Egypt, and Venezuela follow closely behind, each with over 50%. The United States currently has a c-section rate of 32.9%, which U.S. News & World Report explains has risen from 24% in the year 2000.

When the data is unpacked a bit more, it shows that countries with high socioeconomic levels also have high rates of c-sections, but where the growth was most significant were among wealthier women in countries with lower socioeconomic status. In these cases, the surgery is usually being performed on women with low-risk pregnancies, often in private hospitals versus public hospitals.

Check out how countries around the world vary in their use of c-sections in this fascinating chart via ABC. And for our guide on how to prepare for a c-section (both pre-op and post-op), click over here.