Abstract: Background: Cesarean section rates have been increasing worldwide, but little research exists on trends of cesarean section delivery for any country in the Arab world. The purpose of this study was to document recent levels and trends of cesarean section rates in Egypt, and to estimate trends in cesarean section by type of hospital from three population-based national surveys. Methods: This descriptive study used merged data files from three nationally representative samples of ever-married women aged 15 to 49 years. Results: A significant rise in cesarean deliveries occurred for all births, from a low of 4.6 percent in 1992 to 10.3 percent in 2000. However, hospital-based cesarean deliveries were much higher in 1987–1988 (13.9%), increasing to 22.0 percent in 1999–2000. Although the cesarean section rate was slightly higher in private hospitals, the rate also increased consistently in public hospitals. Conclusions: The high and unprecedented increase in cesarean section rates reported in this study may be partly due to cesarean sections that are not medically indicated, and suggest that physician practice patterns, financial incentives or other profitability factors, and patient preferences should be explored. (BIRTH 31:1 March 2004)