The increasing number of caesarean births worldwide concerns pregnant women, obstetric service providers, and the country's economy. Unnecessary caesarean childbirth increases childbirth complications and the cost of health care in low-income countries, including Ethiopia.

This study aims to assess caesarean birth and associated factors at the Sidama region public hospitals, Southern Ethiopia, 2020.

An institution-based cross-sectional study was conducted among 484 women who gave birth at public hospitals in the Sidama region. A multi-stage sampling technique was employed. The data were collected from 1st to 30th of July 2020 by face-to-face interviews using a semi-structured questionnaire (Online Supplement), and the wealth index was analysed by principal component analysis. Backward logistic regression used an adjusted odds ratio and a 95% confidence interval to assess the strength and association between the caesarean section and its associated factors. A P-value of < 0.05 was used to declare statistical significance.

Caesarean childbirth in this study was 34.3%. In this study, partograph monitoring (AOR=2.23, CI=1.13, 4.38), previous caesarean birth (AOR=3.21, CI=1.28,8.17), having genital cutting/mutilation (AOR=2.51, CI=1.14,5.53), intermittent cardiotocography monitoring during childbirth (AOR=2.3, CI=1.14, 4.49), absence of companionship during delivery (AOR=4.97, CI=2.37, 10.43) and is not remembering the last normal menstrual period (AOR=3.12, CI=1.40,6.94) had increased the odds of caesarean birth.

Studies show that the prevalence of caesarean has alarmingly increased in both developed and developing countries. However, the magnitude of caesarean section differs from country to country and in rural and urban areas; the magnitude of caesarean section in this study is much higher than the WHO recommends threshold. The local health bureau and obstetric care providers should pay attention to the caesarean section and need intervention in partograph plotting, companionship, cardiotocography, and female genital mutilation.