INTRODUCTION:
caesarean section rates have increased worldwide in recent decades, with repeat caesarean delivery contributing substantially to this increase. understanding the relative contribution of primary and repeat caesarean sections is essential for informing strategies aimed at reducing unnecessary surgical deliveries.

METHODS:
this cross-sectional study used data from the 2018 iraq multiple indicator cluster survey. women aged 15–49 years with available delivery information were included. caesarean section outcomes were classified as overall, primary, or repeat caesarean section based on previous delivery history. descriptive analyses were conducted using survey-weighted data to produce nationally representative estimates.

RESULTS:
a total of 31060 women were included in the analysis. the overall caesarean section rate was 36.3%. primary caesarean section was relatively uncommon, occurring in 1.6% of deliveries among women with no history of caesarean section. in contrast, repeat caesarean section occurred in 7.9% of deliveries among women with previous births, indicating that repeat procedures accounted for a substantial proportion of the overall caesarean section burden.

CONCLUSIONS:
while primary caesarean section rates were relatively low, repeat caesarean sections contributed markedly to the overall caesarean section burden. interventions aimed at preventing the first caesarean section may help reduce future caesarean delivery rates.