Show simple item record

dc.rights.licenseCreative Commons Attribution 4.0 International License
dc.contributor.authorLaurita Longo, Valentina
dc.contributor.authorOdjidja, Emmanuel Nene
dc.contributor.authorBeia, Thierry Kamba
dc.contributor.authorNeri, Manuela
dc.contributor.authorKielmann, Karina
dc.contributor.authorGittardi, Irene
dc.contributor.authorDi Rosa, Amanda Isabella
dc.contributor.authorBoldrini, Michela
dc.contributor.authorMelis, Gian Benedetto
dc.contributor.authorScambia, Giovanni
dc.contributor.authorLanzone, Antonio
dc.identifier.citationLaurita Longo, V., Odjidja, E.N., Beia, T.K., Neri, M., Kielmann, K., Gittardi, I., Di Rosa, A.I., Boldrini, M., Melis, G.B., Scambia, G. and Lanzone, A. (2020) ‘“An unnecessary cut?” multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review’, BMC Pregnancy and Childbirth, 20(1), p. 770. Available at:
dc.descriptionFrom Springer Nature via Jisc Publications Router
dc.description.abstractBackground: Improvements in medical technologies have seen over-medicalization of childbirth. Caesarean section (CS) is a lifesaving procedure proven effective in reducing maternal and perinatal mortality across the globe. However, as with any medical procedure, the CS intrinsically carries some risk to its beneficiaries. In recent years, CS rates have risen alarmingly in high-income countries. Many exceeding the World Health Organisation (WHO) recommendation of a 10 to 15% annual CS rate. While this situation poses an increased risk to women and their children, it also represents an excess human and financial burden on health systems. Therefore, from a health system perspective this study systematically summarizes existing evidence relevant to the factors driving the phenomenon of increasing CS rates using Italy as a case study. Methods: Employing the WHO Health System Framework (WHOHSF), this systematic review used the PRISMA guidelines to report findings. PubMed, SCOPUS, MEDLINE, Cochrane Library and Google Scholar databases were searched up until April 1, 2020. Findings were organised through the six dimensions of the WHOHSF framework: service delivery, health workforce, health system information; medical products vaccine and technologies, financing; and leadership and governance. Results: CS rates in Italy are affected by complex interactions among several stakeholder groups and contextual factors such as the hyper-medicalisation of delivery, differences in policy and practice across units and the national context, issues pertaining to the legal and social environment, and women’s attitudes towards pregnancy and childbirth. Conclusion: Mitigating the high rates of CS will require a synergistic multi-stakeholder intervention. Specifically, with processes able to attract the official endorsement of policy makers, encourage concensus between regional authorities and local governments and guide the systematic compliance of delivery units with its clinical guidelines.
dc.publisherBioMed Central
dc.relation.ispartofBMC Pregnancy and Childbirth
dc.subjectCaesarean Section
dc.subjectChildbirth Overmedicalisation
dc.subjectHealth Systems Of West Italy
dc.title“An unnecessary cut?” multilevel health systems analysis of drivers of caesarean sections rates in Italy: A systematic review
qmu.authorKielmann, Karina
qmu.centreInstitute for Global Health and Development

Files in this item


This item appears in the following Collection(s)

Show simple item record

Creative Commons Attribution 4.0 International License
Except where otherwise noted, this item's license is described as Creative Commons Attribution 4.0 International License