First birth cesarean proportion: A missed indicator in controlling policies

Area of Science:

• Obstetrics and Gynecology
• Public Health Policy
• Health Services Research

Background:

• High cesarean section (CS) rates in Iran, with nearly half of cases resulting from previous CS.
• The Health Sector Evolution (HSEP) program initiated in April 2014 aims to decrease the prevalent CS rate.
• First Birth Cesarean (FBC) proportion is a key indicator for evaluating CS reduction strategies.

Purpose of the Study:

• To assess the impact of the HSEP program on CS and FBC proportions in Kerman province, Iran.
• To evaluate the effectiveness of interventions targeting high CS rates.
• To determine the sensitivity of FBC proportion as an indicator for CS control programs.

Main Methods:

• Analysis of delivery mode data from Kerman province between March 21, 2014, and March 20, 2015.
• Calculation of FBC proportion: CS in first pregnancies divided by total first births.
• Utilized Chi-square test for trend analysis to evaluate changes over the study period.

Main Results:

• Overall CS rate decreased by 8.9% (from 54.5% to 49.6%), and FBC proportion decreased by 13.1% (from 54.1% to 47%).
• The primary indication for CS remained previous CS.
• Public hospitals demonstrated the most significant reductions in both CS and FBC proportions.

Conclusions:

• The greater reduction in FBC proportion compared to overall CS suggests effective prevention of potential primary CS births.
• FBC proportion is a more sensitive indicator for reflecting the impact of interventions than overall CS rates in the short term.
• Targeting primary CS drivers is crucial for effectively reducing overall cesarean section rates.