Global Preferences and Determinant Variables of Caesarean Delivery Among Pregnant Women: <i>A systematic review and meta-analysis</i>

Abstract

A caesarean section (CS) is a lifesaving procedure. With rising rates, women’s delivery choices have become a global concern. This review assesses global CS preference and determinants. A search of 6 databases was conducted (PubMed, Medline, EMBASE, CINAHL, Google Scholar and Maternity and Infant Care) in accordance with PRISMA guidelines, including papers published between 2013 and 2024. Egger’s test and funnel plot assessed publication bias, while the I2 statistic and Cochrane Q-test evaluated heterogeneity. Subgroup analysis considered sample size, publication year and economic condition. Initially, 73 articles were identified, of which 13 were deemed suitable, with a total sample size of 22,238. The pooled global CS preference was 26%. Subgroup analysis considered economic status, publication year and sample size. Variables associated with CS preference included age >25 years (adjusted odds ratio [AOR] = 4.9, 95% confidence interval [CI]: 1.4–8.4), higher education (AOR = 1.7, 95% CI: 1.05–2.3), urban residency (AOR = 1.9, 95% CI: 1.4–2.4), lack of knowledge of CS (AOR = 2.1, 95% CI: 1.5–3.6) and prior pregnancy complications (AOR = 4.8, 95% CI: 1.4–10). The pooled global CS preference was nearly one-fourth. This review found that an age greater than 25 years, higher education, urban residency, lack of knowledge about CSs and history of previous pregnancy complications were determinant factors for preference for caesarean delivery. As a result, strengthening healthcare systems is essential to improve women’s decision-making regarding mode of delivery.