Growing Rate of Cesarean Section in Iran: Dimensions and Concerns

Evidence on global rising rates of cesarean section (CS) is abundant, of which Iran is no exception.1In the current issue of Archives of Iranian Medicine, Badakhsh et al. have highlighted a significant six-fold rise in the rate of CS in a referral hospital in Tehran during the past 30 years, which is far beyond previous estimates.2–4 The current rate of CS in this study and in accord with previous reports is much higher than WHO recommendations. As stated in a WHO report from 1985, rates above 15% are associated with high rates of inappropriate CS, which endanger maternal and neonatal health and impose a financial burden on the health system.5 On the other hand, CS rates lower than the needs of communities are likewise associated with increased risk of maternal mortality and morbidity.6–8 Because of high socio-economic inequalities in developing countries, both patterns of extremely low or high rates are usually observed. Together with lower safety of the procedure in developing countries compared to the developed world, rates of CS at both ends of the spectrum aggravate the undesirable outcomes of healthcare at regional and national levels.7 However, intrinsic risks related to CS can only be assessed by a randomized controlled trial, which is ethically and practically impossible.9