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Mapping the gendered dynamics of cesarean section: A scoping review
Noah M Trudeau1, Kirantheja Daggula1, Indira Prihartono1
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLOS Global Public Health
|July 17, 2026
Summary
Global cesarean section (CS) rates are rising due to complex social and gendered factors, not just clinical needs. Addressing overuse and underuse requires examining power structures and social conditions influencing childbirth decisions.
Area of Science:
- Obstetrics and Gynecology
- Sociology of Health
- Global Health Equity
Background:
- Cesarean section (CS) rates have significantly increased globally, with disparities in overuse and underuse across different regions and healthcare settings.
- Current explanations often overlook the influence of social and gendered structures on CS decision-making and access.
- This highlights a gap in understanding the multifaceted drivers of CS utilization beyond purely clinical indications.
Purpose of the Study:
- To conduct a scoping review examining how gender norms, roles, and power dynamics influence cesarean section utilization globally.
- To identify and synthesize evidence on gender-related drivers and constraints affecting CS access, decision-making, and delivery practices.
- To analyze the interplay of individual, household, community, and health system factors shaped by gender.
Main Methods:
- A comprehensive scoping review following PRISMA-ScR guidelines, searching PubMed, Scopus, and CINAHL for studies from 2000-2025.
- Inclusion criteria focused on studies explicitly examining gender-related influences on CS.
- Data synthesis employed a thematic analysis using a gender analysis framework, distinguishing between gendered "push" and "pull" factors.
Main Results:
- Ninety-five studies revealed that CS utilization is influenced by interacting gendered forces across multiple levels.
- Key domains include political/economic structures, clinical cultures (paternalism, risk aversion), household/community gender relations, and women's constrained preferences.
- CS is both overused (facilitated by wealth, urban residence, private insurance) and underused (restricted by poverty, isolation, weak health systems) depending on social position and power.
Conclusions:
- Cesarean section is a socially produced intervention embedded within gendered systems of power, not solely a clinical outcome.
- Addressing CS inequities necessitates interventions beyond clinical guidelines, targeting health financing, institutional accountability, provider norms, and social conditions.
- Reproductive agency is significantly shaped by broader social and gendered contexts influencing childbirth choices and access.
