Estimating levels and trends in labour induction worldwide: a systematic review and modelling analysis

Introduction: Induction of labour is a widely used obstetric intervention, yet its use varies markedly, with underuse in some settings and increasing elective use in others. However, the global prevalence and trends worldwide is unknown. We aimed to synthesise national and subnational data to estimate the prevalence of labour induction internationally and assess trends over time. Methods: We sought data from 194 countries through a structured search of national databases and relevant websites. For countries lacking adequate national data, we conducted a systematic review of published studies. Eligible data were pooled to estimate the prevalence of labour induction for 2019, and to examine temporal trends from 2010 to 2022. We used mixed-effects negative binomial regression models with missing data handled using multiple imputation by chained equations. Results: Data were obtained for 62 countries, including national-level data from 19 countries and 176 studies from 43 countries. Overall, 40 countries contributed to the 2019 estimate and 43 to the trend analysis. Most countries with data were high-income (N=37, 86.0%) and in Europe (N=29, 67.4%); there were no eligible data for sub-Saharan Africa. The estimated rate of labour induction for 2019 was 23.7% (95% confidence interval (CI): 19.3% to 29.2%). Induction had an estimated annual increase of 4% between 2010 and 2022 (incidence rate ratio 1.04, 95% CI 1.02 to 1.06). Conclusion: This study provides the first international estimates of labour induction, revealing high and rising rates globally. These trends likely reflect expanded clinical indications and improved access, but also signal potential overuse in resource-rich contexts. Our findings highlight a critical data gap in LMICs, particularly in Sub-Saharan Africa. Strengthening national perinatal data systems, especially in these settings, is essential for monitoring and guiding appropriate use. Identifying the optimal induction rate should be a priority for future research and clinical practice.