I'm genuinely interested. Where do the WHO get their figures from though? How do they decide necessity? What info do they have access to? And why shouldn't it be a matter of opinion of the OB? Is the WHO only talking about women who didn't want a CS and were told they MUST because that's different entirely to the spectrum of situations that actually come up.
Take a woman who is down as having a cs for failure to progress in the second stage and has a cs. Now is that 'necessary' for the purpose of WHO stats. Maybe forceps or ventouse would work in that scenario but maybe the woman refused consent for those (I know plenty of people who have NO TO FORCEPS/VENTOUSE, PROCEED STRAIGHT TO CS' on their birth plans should that situation come up). Perhaps the OB knew the mother, perhaps it was a vbac and s/he knew the additional risks of scar rupture with a prolonged 2nd stage, could see the mother's state of mind, had access to the whole picture of an obstetric history, the events of the day, the mother's wishes etc. I think a lot of CSs could be construed as not imperative but 'necessary' is a judgement call.
DD was in deep transverse arrest. She was unbirthable as they could not rotate her or move her with a ventouse. We'd both be dead without medical intervention. But how much do the WHO know about dd's birth? Because another woman with a baby in DTA might have had a successful rotation. I'm struggling to get a handle on how a cs is deemed 'unnecessary'. My notes say 'reason for cs: DTA'. Another woman's might say 'reason for ventouse: DTA'. Does the possibility for one invalidate need for the other? No, it doesn't. But for statistical collection, how do they measure this?