Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section in Iran: a mixed-methods systematic review

Abstract Background Cesarean section (CS) rates have been increasing globally. Iran has one of the highest CS in world (47.9%). This review was conducted to assess prevalence and reasons for women’s, family members’, health professionals’ preferences Iran. Methods findings In this mixed-methods systematic review, we searched MEDLINE/PubMed, Embase, CINAHL, POPLINE, PsycINFO, Global Health Library, Google scholar; as well Iranian scientific databases including SID, Magiran from 1 January 1990 8th October 2019. Primary quantitative, qualitative, studies that had with Persian or English languages were included. Meta-analysis quantitative by extracting data 65 cross-sectional, longitudinal, baseline measurements interventional studies. For meta-synthesis, used 26 qualitative designs such ethnography, phenomenology, case studies, grounded theory. The Review Manager Version 5.3 Comprehensive Meta-Analysis (CMA) software meta-analysis meta-regression analysis. Results showed 5.46% nulliparous women (95% CI 5.38–5.50%; χ 2 = 1117.39; df 28 [p < 0.00001]; I 97%) preferred a mode delivery. subgroup analysis based on time pregnancy proportions preference reported 5.94% 5.86–5.99%) early middle pregnancy, 3.81% 3.74–3.83%), late pregnancy. heterogeneity high review. Most pregnant, regardless their parity; risk level participants unknown, some publications appraised low quality. A combined inductive deductive approach synthesis data, CERQual confidence findings. Meta-synthesis generated 10 emerging themes three final themes: ‘Women’s factors’, ‘Health professional andex organization, facility, system factors’. Conclusion Despite among women, are still so high. implies role factors beyond individual will. We identified multiple individual, which affected Numerous attempts made recent years design, test implement interventions decrease unnecessary Iran, mother-friendly hospitals, standard protocols labor birth, preparation classes midwives, gynaecologists, workshops specialists midwives through “health sector evolution policy”. Although these programs effective, persist more efforts needed optimize use CS.