Analysing the drivers of unnecessary caesarean sections in developing countries: a systems approach

The World Population Prospects (2022) report by the United Nations highlights a decline in global population growth, underscoring the critical role of healthcare systems in reducing maternal and infant mortality rates. While birth rates vary across high-income and low- and middle-income countries, ensuring safe childbirth remains a fundamental healthcare objective. Despite the known risks associated with unnecessary caesarean sections, their prevalence continues to rise in developing countries. This study examines the underlying factors contributing to this trend, using Iran as a case study. A systems approach is employed, incorporating Causal Loop Diagrams (CLDs) and the Decision Making Trial and Evaluation Laboratory (DEMATEL) to identify and prioritise key influencing factors. The findings suggest that societal and cultural dynamics play a more significant role in the increasing rates of unnecessary caesarean sections than technical medical considerations and individual preferences. Notably, the influence of word-of-mouth and support from reference groups underscores the importance of a community-focused approach in addressing this challenge.