AbstractThe Caesarean section rate in New South Wales in 1977 was estimated to be 9.8%. Regional variation was apparent: Sydney metropolitan 11.1%, Hunter and Illawarra 9.4%, and rural regions 6.8%. The higher rate in the Sydney area, compared to the rural regions, was matched by a greater supply of obstetricians per population. Variations in Caesarean section rates were noted amongst major public hospitals in New South Wales and local government areas in Sydney. The Caesarean section rate in New South Wales was intermediate between the high rate in the United States, and the relatively low rate in England and Wales.It is argued that various factors, apart from medical “need”, have to be invoked to explain the magnitude of, and variation in, the New South Wales Caesarean section rate. These factors may include: supply of obstetricians, introduction of new technology, and fee‐for‐service private p