ArticleBMJ open2023
Behavioural factors associated with fear of litigation as a driver for the increased use of caesarean sections: a scoping review.
Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- Beyond medical indications: exploring nonclinical cesarean section from healthcare providers' perspectives in southeast Iran.BMC health services research · 2026Article
- Knowledge, attitudes and practices of Brazilian obstetricians in relation to childbirth care.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026Article
- Addressing the Increasing Rate of Caesarean Sections in an Australian Healthcare System: A Systems Science Approach to Identify Stakeholder Perspectives.Nursing & health sciences · 2025Article
- Caesarean section for stillborn babies, Benin, Malawi, Uganda and United Republic of Tanzania.Bulletin of the World Health Organization · 2025Article
- Health system drivers of caesarean deliveries in south Asia: a scoping review.The Lancet regional health. Southeast Asia · 2025Review
- Review
- Reducing caesarean section rates in Robson groups 1 and 3: a quality improvement initiative in a private Brazilian hospital.BMJ open quality · 2025Article
- State-wise variation and inequalities in caesarean delivery rates in India: analysis of the National Family Health Survey-5 (2019-2021) data.The Lancet regional health. Southeast Asia · 2025Article
- A qualitative and quantitative cross-sectional study on the past, present, and future of vaginal delivery: Turkey.International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025Article
- Article
- 'Everyone in my family has C-sections': increased likelihood of caesarean birth in family lineages in the United States.Evolution, medicine, and public health · 2025Article
- Trend analysis of caesarean sections using modified Robson's classification in a teaching institution in Uttarakhand.Journal of family medicine and primary care · 2024Article
- How does hospital organisation influence the use of caesarean sections in low- and middle-income countries? A cross-sectional survey in Argentina, Burkina Faso, Thailand and Vietnam for the QUALI-DEC project.BMC pregnancy and childbirth · 2024Article
- A research agenda to improve incidence and outcomes of assisted vaginal birth.Bulletin of the World Health Organization · 2023Article
- A bit of medical paternalism? A qualitative study on power relations between women and healthcare providers when deciding on mode of birth in five public maternity wards of Argentina.Reproductive health · 2023Article
- Global increased cesarean section rates and public health implications: A call to action.Health science reports · 2023Article
Corrections and comments
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Authors and funding
9 authors.
Funding
Abstract
objectiveTo explore the behavioural drivers of fear of litigation among healthcare providers influencing caesarean section (CS) rates.
designScoping review. DATA SOURCES: We searched MEDLINE, Scopus and WHO Global Index (1 January 2001 to 9 March 2022). DATA EXTRACTION AND SYNTHESIS: Data were extracted using a form specifically designed for this review and we conducted content analysis using textual coding for relevant themes. We used the WHO principles for the adoption of a behavioural science perspective in public health developed by the WHO Technical Advisory Group for Behavioural Sciences and Insights to organise and analyse the findings. We used a narrative approach to summarise the findings.
resultsWe screened 2968 citations and 56 were included. Reviewed articles did not use a standard measure of influence of fear of litigation on provider's behaviour. None of the studies used a clear theoretical framework to discuss the behavioural drivers of fear of litigation. We identified 12 drivers under the three domains of the WHO principles: (1) cognitive drivers: availability bias, ambiguity aversion, relative risk bias, commission bias and loss aversion bias; (2) social and cultural drivers: patient pressure, social norms and blame culture and (3) environmental drivers: legal, insurance, medical and professional, and media. Cognitive biases were the most discussed drivers of fear of litigation, followed by legal environment and patient pressure.
conclusionsDespite the lack of consensus on a definition or measurement, we found that fear of litigation as a driver for rising CS rates results from a complex interaction between cognitive, social and environmental drivers. Many of our findings were transferable across geographical and practice settings. Behavioural interventions that consider these drivers are crucial to address the fear of litigation as part of strategies to reduce CS.
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