LAUSR

24 www.thelancet.com Vol 394 July 6, 2019 prevalence of both risk factors was almost twice as high, at 6·8%. On further analysis of the two Indian health surveys, approximately a fifth of the secular increase in CS use in India over 10 years (from 2005–06 to 2015–16) could be attributed to secular trends in maternal phenotype, which comprised significant increases in BMI but minimal increases in height. This finding suggests that a factor contributing to the rising use of CS in poorer countries might be secular increases in maternal BMI co-occurring with negligible increases, or even downward trends, in maternal height, reflecting the widespread persistence of stunting in childhood. Alongside research into unjustified use of CS in many settings, the implications of the emerging dual burden of malnutrition (ie, short maternal height and overweight) might also merit attention. Increased understanding of the links between medically indicated CS, short stature, obesity, and diabetes might help to identify new opportunities for the prevention of medically indicated CS, and provide a greater appreciation of the full health implications associated with the dual burden of malnutrition in women.