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To determine the general contextual effect of the department in the variation of Cesarean section in Colombia in 2016, and their individual and contextual related factors. Cross-sectional study based on a birth cohort. We used the birth certificate database from January 1 to December 31, 2016. Three multilevel logistic models were constructed. Pregnant women were set at the first level and department at the second level. We fitted a null multilevel model followed by two multiple models, including individual and individual and departme