How the probability of giving birth with a C-section in Spain depends on the hospital a woman goes to

Entry type: Single project

Country/area: Spain

Publishing organisation: elDiario.es

Organisation size: Big

Publication date: 2022-10-16

Language: Spanish

Authors: Raúl Sánchez, Ana Requena, Sandra Vicente, Lucracia Hevia, Maialen Ferreira, Francisca Bravo, Laura Martínez


Raúl Sánchez: journalist and coordinator of elDiario.es data team.

Ana Requena: journalist chief gender editor at elDiario.es.

Sandra Vicente: journalist and reporter at elDiario.es Catalonia regional team.

Lucrecia Hevia: journalist and Andalucia regional team’s editor.

Maialen Ferreira: journalist and reporter at elDiario.es Euskadi regional team.

Francisca Bravo: journalist and reporter at elDiario.es Castile-La Mancha regional team.

Laura Martínez: journalist and reporter at elDiario.es Valencia regional team.

Project description:

A journalistic investigation that reveals for the first time in Spain the rate of caesarean sections across 360 public and private hospitals, that allow the public to determine if hospital’s are using more than medical criteria to define how a woman should give birth. By unveiling the data hidden in anonymized records requested by the journalists to the Health Ministry, the project investigated the phenomena behind the data on how a C-section is determined by resources, weekdays, doctor’s schedules or the health policy of your hospital or region, among other reasons.

Impact reached:

For the first time, we revealed the C-section rates of almost all public and private hospitals in Spain. Never before have women and citizens in the country have had this data available to make better informed decisions about their childbirth. In fact, making this available as a service was the main goal of this project. For example, this investigation allowed a lot of hospital managers and chiefs of obstetrics to know their C-section rate in comparison with other hospitals of the country, their region or even the same city, which could lead to a change of policies based on data.

The investigation reveals that 28 hospitals had a C-section rate of more than 45%, roughly triple the ideal rate, an indicator that these centers are doing unnecessary C-sections.

In addition, several organizations related to the promotion of natural childbirth shared the research and congratulated the newspaper for revealing this data. This publication also opened a sharing space, during days women in social media shared their experiences of obstetric violence or cases of scheduled births with C-sections without being needed. This interaction showed how the data is related to personal experiences and proved a systematic phenomena.

The core investigative team collaborated with our regional editions to do powerful and local stories about causes that explain the rates of individual hospitals or about health policies carried out by regional health departments. More than 20 pieces were published in the investigation including a podcast episode. The main publication has been viewed by more than 200.000 users and it was one of the most visited this year. The story opened the elDiario.es front page for two consecutive days and it was included in Top 10 Data Journalism Projects from 2022 at GIJN.

Techniques/technologies used:

We used Google Spreadsheets, Excel and R programming language for data compilation and analysis. Datawrapper, Javascript and D3 for data visualization.

Context about the project:

The information was obtained after a legal battle lasting several months in which the government refused to provide the information. This project started with a freedom of information request where we asked for the C-sections rates of all hospitals in Spain. Information that is held by the Ministry of Health but has never been released to the public. First, the Government declined to reveal this data. elDiario.es sent a complaint to the Transparency Council, the body in charge of ensuring compliance with the law, which agreed with this media and forced the Government to send the requested information. The Ministry of Health understood it in its own way and they sent us the anonymized records on C-section deliveries of each hospital in Spain, but unidentified.

To identify all hospitals included in the anonymized records, we cross-reference these data with open data sources like annual reports, official websites, public documents, health databases, scientific papers and archived websites. Finally we were able to detect 360 Spanish public and private hospitals in our data.

This analysis lead us to prove that the probability of giving birth by caesarean section multiplies depending on the hospital a woman goes to. This analysis shows the wide disparities of the C-section rate between regions, public and private hospitals or even between hospitals located in the same city.

We interviewed more than 20 obstetricians, experts, doctors, hospital managers and senior officials to understand the reasons behind this gap between hospitals. For example: the lack of resources of some public hospitals located in rural areas, the economic approach of private health sector where doctors schedule births on weekdays to avoid working on weekends or holidays or preventing natural birthing, the interventional model of childbirth or the outdated protocols of some hospitals that indicates a caesarian section in case of any complication.

What can other journalists learn from this project?

This project proves that we journalists can fight against Governments that don’t want to disclose information and it shows other colleagues that anonymized data can be desanonymized. The identity of public institutions (like hospitals) shouldn’t be protected because accountability of public administration is essential in democracy. This investigation of hospitals that abuse C-sections creates a methodology to cross-reference anonymized records with open data sources that can be copied by other professionals.

Also, it can inspire journalists from other countries to request public data on C-section rates in all hospitals to analyze the evolution of the medicalization of childbirth in each country and also to check if the probability of giving birth with a C-section depends on the hospital a woman goes to. Is there a trend in other countries to give birth with a caesarian section or to schedule births on working days to avoid holidays? This can be a crossborder project that tries to collect hospital data from a list of countries.

Project links: