# Global Preferences and Determinant Variables of Caesarean Delivery Among Pregnant Women: A systematic review and meta-analysis

## TL;DR

This study finds that about 26% of pregnant women globally prefer caesarean delivery, influenced by factors like age, education, and urban living.

## Contribution

The study provides a global meta-analysis of caesarean delivery preferences and identifies key demographic and socioeconomic determinants.

## Key findings

- The pooled global preference for caesarean delivery was 26%.
- Age over 25, higher education, and urban residency were linked to higher CS preference.
- Lack of knowledge about CS and prior pregnancy complications also increased preference.

## Abstract

A caesarean section (CS) is a lifesaving procedure. With rising rates, women's delivery choices have become a global concern. This review assesses global CS preference and determinants. A search of 6 databases was conducted (PubMed, Medline, EMBASE, CINAHL, Google Scholar and Maternity and Infant Care) in accordance with PRISMA guidelines, including papers published between 2013 and 2024. Egger's test and funnel plot assessed publication bias, while the I2 statistic and Cochrane Q-test evaluated heterogeneity. Subgroup analysis considered sample size, publication year and economic condition. Initially, 73 articles were identified, of which 13 were deemed suitable, with a total sample size of 22,238. The pooled global CS preference was 26%. Subgroup analysis considered economic status, publication year and sample size. Variables associated with CS preference included age >25 years (adjusted odds ratio [AOR] = 4.9, 95% confidence interval [CI]: 1.4–8.4), higher education (AOR = 1.7, 95% CI: 1.05–2.3), urban residency (AOR = 1.9, 95% CI: 1.4–2.4), lack of knowledge of CS (AOR = 2.1, 95% CI: 1.5–3.6) and prior pregnancy complications (AOR = 4.8, 95% CI: 1.4–10). The pooled global CS preference was nearly one-fourth. This review found that an age greater than 25 years, higher education, urban residency, lack of knowledge about CSs and history of previous pregnancy complications were determinant factors for preference for caesarean delivery. As a result, strengthening healthcare systems is essential to improve women's decision-making regarding mode of delivery.