Trends in Caesarean section deliveries in Jordan from 1982 to 2017: retrospective analyses of annual hospital reports

Background: According to the World Health Organization, the ideal caesarean section rate is 10-15% but rates have increased worldwide over the past few decades. Data on caesarean section rates across all Jordanian health sectors over a long period, including recent data that could guide future healthcare policy and interventions, are currently unavailable. Aims: To investigate caesarean sections trends and identify indications (medical and sociodemographic) associated with caesarean sections in Jordanian health sectors. Methods: Medical records of 2.8 million births in Jordan in 1982-2017 were retrieved and analysed. CS trends were compared across health sectors (governmental, university, private, and military hospitals) and with trends in England, Lebanon and Islamic Republic of Iran. CS indications were established from retrospective data, based on 3799 CS births, in 2 hospitals (governmental and private). Results: The CS rate in Jordan increased over the study period from 5.8 (+/- 1.9)% in 1982-1987 to 31.0 (+/- 0.7)% in 2015-2017. The caesarean sections rate in Jordan was initially lower (1983-2006) then became comparable (2007-2014) to that in England, but lower compared to that in Lebanon (2011-2016). In 2015-2017, caesarean sections rates in Jordanian health sectors were: 40.4 (+/- 2.6)% (university), 391 (+/- 1.8)% (private), 36.1(+/- 0.2)% (military) and 27.4 (+/- 0.7)% (governmental). Previous CS (33.6%), abnormal presentation (20.3%), and patient request (16%) were the most common indications. Conclusions: The CS rate in Jordan is on an alarming upward trend. Urgent action is needed to prevent further increase in CS rate, including provision of clear information, advice, and counselling to pregnant women, as well as strict adherence to high-quality medical guidelines.