Multi-level factors influencing caesarean section preferences among women in low- and middle- income countries: A systematic review
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Issued Date
2025-08-01
Resource Type
ISSN
02666138
Scopus ID
2-s2.0-105003258984
Journal Title
Midwifery
Volume
147
Rights Holder(s)
SCOPUS
Bibliographic Citation
Midwifery Vol.147 (2025)
Suggested Citation
Bubpawong S., Nuampa S., Ratinthorn A., Ruchob R. Multi-level factors influencing caesarean section preferences among women in low- and middle- income countries: A systematic review. Midwifery Vol.147 (2025). doi:10.1016/j.midw.2025.104423 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/109891
Title
Multi-level factors influencing caesarean section preferences among women in low- and middle- income countries: A systematic review
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Abstract
Background: Women's preferences regarding caesarean section (CS) are a significant contributing factor to the increasing and widely varying rates of this procedure across countries and regions. This trend is particularly pronounced in low- and middle-income countries (LMICs), where both overuse and underuse of CS can pose significant health risks. Understanding the multi-level factors influencing CS preferences is essential for promoting the appropriate use of this procedure and ensuring optimal maternal and neonatal health outcomes. Aim: To systematically review literature examining multi-level factors influencing CS preferences among women in LMICs through ecological systems and exploring the prevalence of CS preferences. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Six electronic databases were searched: Academic Search Ultimate (EBSCO), MEDLINE (EBSCO), Nursing & Allied Health Premium (ProQuest), PubMed, ScienceDirect, and Scopus. The search included studies published from January 2014 to August 2024. The quality of each article was assessed using the Joanna Briggs Institute's critical appraisal tool. Findings: A total of 17 studies were included in this review. The proportion of CS preferences varied significantly, ranging from 8.8 % to 58 % in LMICs. The multi-level factors influencing CS preferences were summarized across four levels, based on ecological systems: microsystem level (sociodemographic factors, reproductive factors, psychological factors, and literacy-related factors), mesosystem level (healthcare influence, family and relative influence), exosystem level (healthcare environment and social media influence), and macrosystem level (socio-cultural factors). Conclusion: Factors within the microsystem, mesosystem, and macrosystem levels displayed the substantial influence aligned with ecological systems. To reduce unnecessary CS, future research should comprehensively explore multi-level factors. Policymakers should implement prominent factors across the system.