Main Reasons for Increased Cesarean Section Rate in Yerevan: Knowledge, Attitude, and Practice Analysis

Abstract

The high rate of cesarean sections (CS) is recognized worldwide as a major public health problem. CS rates exceeding the 15% standard recommended by the WHO have adverse effects on maternal and neonatal morbidity and mortality and carry financial losses which are felt more acutely in developing countries with scarce resources. Over the past ten years, Armenia has experienced a huge increase in its CS rate, from 7.2 to 18.6%. The current level, higher than that recommended by the WHO is the main reasons for investigating the factors contributing to this observed increase. Since there have been no studies about CSs in Armenia to date, qualitative research methods were chosen. In total, 12 in-depth interviews were conducted with intranatal and antenatal doctors, as well as with policy-makers working in the field of maternal health. Twenty seven cesarean, naturally delivered and first-time pregnant women participated in three focus group discussions. Directed content analysis was used for analyzing the data. The primary causes of the increased CS rate were identified; among them, a lack of explicit clinical indications for CS, increased number of medical indications, increased morbidity, and maternal requests for CS, and physicians’ financial incentives. Educational programs, changes in standards and current guidelines, as well as implementation of internationally accepted practices of vaginal deliveries among women with cesarean section in the past, might play an important role in reducing the unnecessary CS rate. Further investigations are required for making improvements in the financial and regulatory strategy of CSs without indications and to assess the impact of the new reimbursement system and maternal requests for CS on its increased rate.