Document Type : Original Research Article
Authors
1
Professor, Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
2
MSc in Mental Health, Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
3
PhD Student in Health Economics, Iran University of Medical Sciences, Tehran, Iran
4
a) Assistant Professor, Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran b) Department of Healthcare Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Abstract
Background & aim: Cesarean section (CS) is a life-saving intervention in specific obstetric situations but has become increasingly common worldwide. This study investigated socioeconomic, maternal, neonatal, and health system determinants of delivery mode in Tehran Province, Iran, from March 2023 to March 2024.
Methods: This cross-sectional study included 400 mothers selected through stratified urban–rural sampling. Data were collected at healthcare facilities using a researcher-developed questionnaire covering demographic, socioeconomic, maternal, and obstetric characteristics and mode of delivery. Data were analyzed using Chi-square and Mann–Whitney U tests, followed by Firth’s penalized binary logistic regression in Stata 17.
Results: Overall, 62% of participants had CS. Maternal age >31 years (OR = 4.02; 95% CI: 1.49–10.87), public-sector maternal employment (OR = 4.50; 95% CI: 1.66–12.22), and supplementary health insurance (OR = 2.01; 95% CI: 1.10–3.68) were associated with higher odds of CS. A history of stillbirth (OR = 0.06; 95% CI: 0.01–0.48), participation in birth-preparation classes (OR = 0.41; 95% CI: 0.24–0.69), and delivery in public hospitals or at home versus private hospitals (OR = 0.30; 95% CI: 0.16–0.56) were associated with lower odds of CS.
Conclusion: Delivery mode is influenced by multiple socioeconomic, maternal, and health system factors, highlighting the importance of supportive prenatal services and evidence-based policies.
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