This paper analyses the incidence of caesarian sections (C-sections) in Brazil. In the last decade, it has reached an extremely high level, higher than in any other country in the world. Socioeconomic and regional differences are established, using available national data on the caesarian section rate, which is higher in more prosperous regions and among wealthier women. The different factors influencing this high incidence, including sociocultural, obstetric care organization and legal and institutional considerations are analysed. Special attention is given to the problem of female surgical sterilization, which is not officially accepted in the country, but is performed during a C-section with no other maternal or foetal indication. Consequences relating to maternal and perinatal morbidity and mortality, population fertility and the cost of health services are discussed. Interventions to reverse this trend toward higher caesarian section rates are proposed.