The effect of the health transformation plan on cesarean section in Iran: a systematic review of the literature.

Objective: Cesarean section (CS) is one of the most common surgical procedures in the world. In developed and developing countries, CS has grown significantly over the past decades. The Iranian Ministry of Health and Medical Education has developed a health transformation plan (HTP) in order to reduce CS rate and promote vaginal delivery. This study was conducted with the aim of reviewing the results of published studies on the impact of the HTP on CS in Iran.

Results: We searched Embase, PubMed/MEDLINE, ISI/Web of Sciences, Scopus, as well as Iranian databases (MagIran, SID and Barakatkns), from May 2014 to October 2018. To assess the quality of studies, the checklist "A Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions" was utilized. Twelve studies were selected. Seven studies reported statistically significant results, showing a positive impact of the implementation of the HTP on CS reduction. Despite the decreased CS rate in Iran after about 4 years of the implementation of this policy, the goal of a yearly reduction by 10% has not been achieved yet. Increasing access to maternity services and community-based education through mass media could help changing the attitudes of Iranian mothers towards CS.