SynthesisBMC pregnancy and childbirth2022
Classifying caesarean section to understand rising rates among Palestinian refugees: results from 290,047 electronic medical records across five settings.
Synthesis in BMC pregnancy and childbirth, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 7 citations in OpenAlex.
- Maternal outcomes and access to maternal healthcare services among migrant, refugees and forced displaced women in the Middle East and North Africa: A systematic scoping review.International journal of nursing studies advances · 2026Review
- Mode of delivery and anesthesia in adolescents: a comparative analysis of Turkish and refugee populations.Reproductive health · 2025Article
- The Contribution of AIDA (Artificial Intelligence Dystocia Algorithm) to Cesarean Section Within Robson Classification Group.Journal of imaging · 2025Article
- Post-term births as a risk factor for small for gestational age births and infant mortality in Brazil, Mexico, and Palestinian refugees: An analysis of electronic birth records.Paediatric and perinatal epidemiology · 2025Article
- Addressing health disparities: Palliative care for migrants and refugees in the Eastern Mediterranean Region.Asia-Pacific journal of oncology nursing · 2023Article
- Quality of maternal and newborn health care at private hospitals in Iraq: a cross-sectional study.BMC pregnancy and childbirth · 2023Article
- Establishment of a birth-to-education cohort of 1 million Palestinian refugees using electronic medical records and electronic education records.International journal of population data science · 2023Article
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Authors and funding
7 authors at 2 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundRising caesarean-section rates worldwide are driven by non-medically indicated caesarean-sections. A systematic review concluded that the ten-group classification system (Robson) is the most appropriate for assessing drivers of caesarean deliveries. Evidence on the drivers of caesarean-section rates from conflict-affected settings is scarce. This study examines caesareans-section rates among Palestinian refugees by seven-group classification, compares to WHO guidelines, and to rates in the host settings, and estimates the costs of high rates.
methodsElectronic medical records of 290,047 Palestinian refugee women using UNRWA's (United Nations Relief and Works Agency for Palestine Refugees in the Near East) antenatal service from 2017-2020 in five settings (Jordan, Lebanon, Syria, West Bank, Gaza) were used. We modified Robson criteria to compare rates within each group with WHO guidelines. The host setting data were extracted from publicly available reports. Data on costs came from UNRWA's accounts.
findingsPalestinian refugees in Gaza had the lowest caesarean-section rates (22%), followed by those residing in Jordan (28%), West Bank (30%), Lebanon (50%) and Syria (64%). The seven groups caesarean section classification showed women with previous caesarean-sections contributed the most to overall rates. Caesarean-section rates were substantially higher than the WHO guidelines, and excess caesarean-sections (2017-2020) were modelled to cost up to 6.8 million USD. We documented a steady increase in caesarean-section rates in all five settings for refugee and host communities; refugee rates paralleled or were below those in their host country.
interpretationCaesarean-section rates exceed recommended guidance within most groups. The high rates in the nulliparous groups will drive future increases as they become multiparous women with a previous caesarean-section and in turn, face high caesarean rates. Our analysis helps suggest targeted and tailored strategies to reduce caesarean-section rates in priority groups (among low-risk women) organized by those aimed at national governments, and UNRWA, and those aimed at health-care providers.
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