ArticlePloS one2025
Contribution of women's preference to the overuse of caesarean sections: A propensity score matching analysis based on a multi-country cross-sectional survey, as part of the QUALI-DEC project.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
2 citing papers in PubMed.
- Implementation of a decision aid to promote shared decision-making on mode of birth in low-risk pregnant women: a cross-sectional study within the QUALI-DEC hybrid trial.BMJ global health · 2026Trial
- Impact of scheduled cesarean sections on non-working days on maternal and neonatal outcomes: a retrospective cohort study based on propensity score matching.Frontiers in medicine · 2026Article
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Authors and funding
10 authors.
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Abstract
introductionMaternal request for caesarean section has often been cited to justify the increasing caesarean section rates worldwide. However, we lack evidence on the impact of women's preference for caesarean section on this dramatic tendency. Given the need to develop appropriate strategies to reduce unnecessary caesarean section, the objective of this study was to assess the association between women's preference for caesarean section and its actual use, and to estimate the proportion of caesarean section associated with women's preference for caesarean section in Argentina, Burkina Faso, Thailand and Viet Nam.
methodsA cross-sectional hospital-based survey among postpartum women was conducted in 32 hospitals (8 per country) between 2020 and 2022. We selected women with no potential medical indication for caesarean section among a random sample of women who delivered in participating facilities during the data collection period. We chose a propensity score matching approach, to compare the probability of giving birth by caesarean section between women who, late in pregnancy, preferred caesarean section and those who preferred vaginal birth.
resultsA total of 1,827 low-risk women were included, of whom 10.4% preferred a caesarean section and the average caesarean section rate was 24.5%. The results show that, on average, preference for caesarean section increased the probability of having a caesarean section by 32% (CI 95% [0.23-0.41]; p < 0.001). The relative risk was estimated at 2.69 (CI 95%: 2.43; 2.95) and the fraction of caesarean section associated with women's preference was estimated at 15% (CI 95%: 12.9% - 16.9%).
conclusionAlthough women's preference plays a role in the use of caesarean section in the participating hospitals, it likely accounts for only a small proportion of the caesarean section performed, highlighting the need for multidimensional, context-specific strategies to reduce unnecessary caesarean sections (providing women with evidence-based information, improving clinicians' adherence to guidelines and shared decision-making, addressing systemic factors…).
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