The objective of this work is to describe the evolution of cesarean section rates in Spain from 1984 through 1988. National rates increased from 9.92% to 19.99%. Trend is significantly rising nationwide and in all Communities. Overall differences have decreased (CSV from 1.73 to 11.72) because there are two groups of regions: one with high rates, the other one with low rates. Rates are significantly higher in private hospitals (14.53%). These differences could show the controversy and uncertainty in the indications and the influence of organizational factors. Although new sources of information to obtain population rates and outcomes studies adjusted by women clinic and sociodemographic characteristics are due to be developed, these differences lead to suspect that there is a gap between the theoretic quality medical science could provide and the actual quality medical practice is providing, explained just by reasons out from clinical factors.