The Rate of Cesarean Section and Its Indications Before and After the Implementation of Health System Reform in the Hospitals of Mazandaran Province, 2013-2016

Background and Increase in cesarean section (C-Section) is a health system problem around the world. The aim of this study was to compare the rate of C-Section and indications for that before and after implementation of Health System Reform in the hospitals of Mazandaran province, Iran. This descriptive cross-sectional study was conducted analytically. The indications for C-Section were recorded based on curative treatment checklist before implementation of the Health System Reform (2013) and after that (2016). Data were analyzed in SPSS V21 applying t-test and Chi-square. The rate of C-Section was significantly lower only in governmental hospitals after implementation of the Health System Reform (P< 0.05). Among the indications of C-Section, only the previous C-Section had a significant difference before and after the Health System Reform in total hospitals in the province (P<0.002). Significant differences were found between previous C-Section (P<0.025) and its increasing trend, and post-term pregnancy (P<0.027) and decreasing trend before and after the Health System Reform in governmental hospitals. Other indices were not significantly different between public, private, and Social Security Organization hospitals (P<0.05). Implementation of Health System Reform was effective in decreasing the rate of C-section in governmental hospitals. It is hoped that with appropriate implementation of the program, along with cultural and social programs, we could get closer to Iran’s scientific goals and decrease the rate of C-Section according to global standards