Mahboubeh Shirzad1, Elham Shakibazadeh2, Khadijeh Hajimiri3, Ana Pilar Betran4, Shayesteh Jahanfar5,6, Meghan A Bohren7, Newton Opiyo4, Qian Long8, Carol Kingdon9, Mercedes Colomar10, Mehrandokht Abedini11. 1. Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Second floor, Building Two, Poursina Avenue, Tehran, Iran. 2. Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Second floor, Building Two, Poursina Avenue, Tehran, Iran. shakibazadeh@tums.ac.ir. 3. Department of Health Education and Promotion, School of Public Health, Zanjan University of Medical Sciences, Zanjan, Iran. 4. Department of Reproductive Health and Research, UNDP/UNFPA, UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland. 5. School of Public Health, Central Michigan University, Michigan, USA. 6. Department of Public Health and Community Medicine, School of Medicine, Tufts University, Tufts, USA. 7. Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia. 8. Global Health Research Center, Duke Kunshan University, Kunshan,, Jiangsu, China. 9. School of Community Health and Midwifery, University of Central Lancashire, Preston, UK. 10. Montevideo Clinical Research Unit (UNICEM), Montevideo, Uruguay. 11. Maternal Health Department, Ministry of Health, Tehran, Iran.
Abstract
BACKGROUND: Cesarean section (CS) rates have been increasing globally. Iran has one of the highest CS rates in the world (47.9%). This review was conducted to assess the prevalence of and reasons for women's, family members', and health professionals' preferences for CS in Iran. METHODS AND FINDINGS: In this mixed-methods systematic review, we searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, Google scholar; as well as Iranian scientific databases including SID, and Magiran from 1 January 1990 to 8th October 2019. Primary quantitative, qualitative, and mixed-methods studies that had been conducted in Iran with Persian or English languages were included. Meta-analysis of quantitative studies was conducted by extracting data from 65 cross-sectional, longitudinal, and baseline measurements of interventional studies. For meta-synthesis, we used 26 qualitative studies with designs such as ethnography, phenomenology, case studies, and grounded theory. The Review Manager Version 5.3 and the Comprehensive Meta-Analysis (CMA) software were used for meta-analysis and meta-regression analysis. Results showed that 5.46% of nulliparous women (95% CI 5.38-5.50%; χ2 = 1117.39; df = 28 [p < 0.00001]; I2 = 97%) preferred a CS mode of delivery. Results of subgroup analysis based on the time of pregnancy showed that proportions of preference for CS reported by women were 5.94% (95% CI 5.86-5.99%) in early and middle pregnancy, and 3.81% (95% CI 3.74-3.83%), in late pregnancy. The heterogeneity was high in this review. Most women were pregnant, regardless of their parity; the risk level of participants were unknown, and some Persian publications were appraised as low in quality. A combined inductive and deductive approach was used to synthesis the qualitative data, and CERQual was used to assess confidence in the findings. Meta-synthesis generated 10 emerging themes and three final themes: 'Women's factors', 'Health professional factors', andex 'Health organization, facility, or system factors'. CONCLUSION: Despite low preference for CS among women, CS rates are still so high. This implies the role of factors beyond the individual will. We identified a multiple individual, health facility, and health system factors which affected the preference for CS in Iran. Numerous attempts were made in recent years to design, test and implement interventions to decrease unnecessary CS in Iran, such as mother-friendly hospitals, standard protocols for labor and birth, preparation classes for women, midwives, and gynaecologists, and workshops for specialists and midwives through the "health sector evolution policy". Although these programs were effective, high rates of CS persist and more efforts are needed to optimize the use of CS.
BACKGROUND: Cesarean section (CS) rates have been increasing globally. Iran has one of the highest CS rates in the world (47.9%). This review was conducted to assess the prevalence of and reasons for women's, family members', and health professionals' preferences for CS in Iran. METHODS AND FINDINGS: In this mixed-methods systematic review, we searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, Google scholar; as well as Iranian scientific databases including SID, and Magiran from 1 January 1990 to 8th October 2019. Primary quantitative, qualitative, and mixed-methods studies that had been conducted in Iran with Persian or English languages were included. Meta-analysis of quantitative studies was conducted by extracting data from 65 cross-sectional, longitudinal, and baseline measurements of interventional studies. For meta-synthesis, we used 26 qualitative studies with designs such as ethnography, phenomenology, case studies, and grounded theory. The Review Manager Version 5.3 and the Comprehensive Meta-Analysis (CMA) software were used for meta-analysis and meta-regression analysis. Results showed that 5.46% of nulliparous women (95% CI 5.38-5.50%; χ2 = 1117.39; df = 28 [p < 0.00001]; I2 = 97%) preferred a CS mode of delivery. Results of subgroup analysis based on the time of pregnancy showed that proportions of preference for CS reported by women were 5.94% (95% CI 5.86-5.99%) in early and middle pregnancy, and 3.81% (95% CI 3.74-3.83%), in late pregnancy. The heterogeneity was high in this review. Most women were pregnant, regardless of their parity; the risk level of participants were unknown, and some Persian publications were appraised as low in quality. A combined inductive and deductive approach was used to synthesis the qualitative data, and CERQual was used to assess confidence in the findings. Meta-synthesis generated 10 emerging themes and three final themes: 'Women's factors', 'Health professional factors', andex 'Health organization, facility, or system factors'. CONCLUSION: Despite low preference for CS among women, CS rates are still so high. This implies the role of factors beyond the individual will. We identified a multiple individual, health facility, and health system factors which affected the preference for CS in Iran. Numerous attempts were made in recent years to design, test and implement interventions to decrease unnecessary CS in Iran, such as mother-friendly hospitals, standard protocols for labor and birth, preparation classes for women, midwives, and gynaecologists, and workshops for specialists and midwives through the "health sector evolution policy". Although these programs were effective, high rates of CS persist and more efforts are needed to optimize the use of CS.
Authors: A J Macfarlane; B Blondel; A D Mohangoo; M Cuttini; J Nijhuis; Z Novak; H S Ólafsdóttir; J Zeitlin Journal: BJOG Date: 2015-03-09 Impact factor: 6.531
Authors: Ties Boerma; Carine Ronsmans; Dessalegn Y Melesse; Aluisio J D Barros; Fernando C Barros; Liang Juan; Ann-Beth Moller; Lale Say; Ahmad Reza Hosseinpoor; Mu Yi; Dácio de Lyra Rabello Neto; Marleen Temmerman Journal: Lancet Date: 2018-10-13 Impact factor: 79.321
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