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Background: Caesarean rates are increasing in Brazil and worldwide, and there is a concern regarding the consequences of this increase for maternal and child health. Objective: This study aimed to analyse the proportions and the time trend of cesarean sections in the Health Region of Paraná State. Method: This is a time-series ecological study using data from the Information System on Live Births. The analyzes of the proportions and trends of cesarean sections were performed between 2003 and 2014, in three-year periods. Linear regression was used to analyze cesarean rate trends, with the significance level set at 5%. Results: The largest proportions of cesarean sections occurred between 2012 and 2014 (53.8% to 80.2%), except for the 1st Health Region (Paranaguá), with larger proportions between 2009 and 2011. All the regional ones presented an increasing trend in the proportion of cesarean sections (all p values < 0.05), except the 1st Health Region that remained with a steady trend (p = 0.10). The vast majority of the Health Region of Paraná State presented a higher proportion of cesarean sections than Brazil, for all three-year periods. Conclusion: The results indicate high proportions of cesarean sections in the Health Region in Paraná State and the vast majority showed an increasing trend of cesarean sections. [ABSTRACT FROM AUTHOR]