Objective: To investigate the change in C-section rate in 1998-2017 in Indonesia and explore the socioeconomic, geographic, and health system factors associated with the use of C-sections. Design: Analysis from demographic health survey (DHS) data in 2002-3, 2007, 2012, and 2017. Setting: Nationwide. Population: 40743 women who reported giving birth within five years of each round of the survey. Methods: Cross-tabulation was used to examine change of C-section rate by year. We conducted bivariate and multivariate logistic regressions to study the determinants of C-section use. Main outcome measures: C-section rate at the population level. Results: In Indonesia, C-section rate increased from 4.0% in 1998 to 18.5% in 2017. In 2017, C-section rate in urban areas (22.9%) was almost two times that in rural areas (11.8%). It was almost three times among the richest wealth quintile (36.5%), compared to the poorest wealth quintile (12.9%). Between 2008 and 2017, the difference in C-section rate by public services enlarged between the poorest and the richest groups. The absolute increase of C-section by private services was more than public services over time. In 2013-2017, the C-section rates by public and private services were 22.5% and 23.1%, respectively. After adjusting for all variables, higher education, higher household wealth, primiparity, and use of public childbirth services were positively associated with C-section. Conclusions: The C-section rate increased steadily in the past two decades in Indonesia. Women’s socioeconomic status and health system factors were associated with the increased use of C-section.