Iranian Society of Gynecology Oncology


1 Treatment Deputy, Department of Health Economics, Kurdistan University of Medical Sciences, Sanandaj, Iran

2 Social Determinant of Health Research Centre, Kurdistan University of Medical Sciences, Sanandaj, Iran

3 Department of Health Services Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

4 Treatment Deputy of Kurdistan University of Medical Sciences, Sanandaj, Iran

5 Support and Resources Deputy of Kurdistan University of Medical Sciences, Sanandaj, Iran


Background: Since April 22, 2014, the natural childbirth promotion package has been implemented in the form of the Health Transformation Plan (HTP) to decrease the cesarean section rate in Iran. This study aimed to determine the amount of subsidy allocated to the natural childbirth package and to examine its effects on the cesarean section rate in hospitals affiliated with Kurdistan University of Medical Sciences (KUMS), Kurdistan Province, Iran.
Methods: This is a descriptive study implemented by retrospective and longitudinal design. The population in this study to determine the budget amount allocated to “childbirth promotion package” and all mothers that had natural childbirth deliveries from May 5, 2014 (beginning of HTP) to September 2015 in hospitals affiliated with KUMS. Study populations to determine the C-section ratio included all mothers who had deliveries in hospitals affiliated with KUMS from December 2012 to May 4, 2014 (before HTP) and from May 5, 2014 to September 2015 (after HTP). Using a checklist, the required data was collected from the Statistics and Health Economics Department of Treatment Deputy of KUMS. Afterwards, the obtained data were described using the descriptive statistical indicators including frequency, percent, and mean via Microsoft Excel 2013 (Microsoft Corp., Redmond, WA, USA).
Results: Since the beginning of implementing the natural childbirth promotion package until September 21, 2015, a total of 23 566 mothers had natural childbirth deliveries in the hospitals affiliated with KUMS. These mothers benefited from a total amount of 23 939 046 090 IRR provided by the natural childbirth package. In addition, the cesarean ratio has decreased 7% after implementing HTP.
Conclusions: It seems that HTP caused for the cesarean ratio to decrease in hospitals affiliated to KUMS. Further studies are recommended to determine the causality between a decrease in cesarean rate and HTP. 


  1. Gibbons LJM, Belizan JA, Lauer AP, Betran M, Merialdi F. Althabe, The global numbers and costs of additionally needed and unnecessary caesarean sections performedper year: overuse as a barrier to universal coverage. World health report; 2010. pp. 1-31.
  2. Joesch JM, Gossman GL, Tanfer K. Primary cesarean deliveries prior to labor in the United States, 1979-2004. Matern Child Health J. 2008;12(3):323-31. [DOI:10.1007/s10995-007-0255-7] [PMID]
  3. Baldo MH. Caesarean section in countries of the Eastern Mediterranean Region. East Mediterr Health J. 2008;14(2):470-88.
  4. Stavrou EP, Ford JB, Shand AW, Morris JM, Roberts CL. Epidemiology and trends for Caesarean section births in New South Wales, Australia: a population-based study. BMC Pregnancy Childbirth. 2011;11:8. [DOI:10.1186/1471-2393-11-8] [PMID]
  5. Bahadori F, Hakimi S, Heidarzade M. The trend of caesarean delivery in the Islamic Republic of Iran. Eastern Mediterranean Health J. 2013;19(2):1. [DOI:10.26719/2013.19.Supp3.S67]
  6. Piroozi B, Moradi G, Nouri B, Mohamadi Bolbanabad A, Safari H. Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran. Int J Health Policy Manag. 2016;5(7):417-23. [DOI:10.15171/ijhpm.2016.31] [PMID]
  7. Moradi-Lakeh M, Vosoogh-Moghaddam A. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns. Int J Health Policy Manag. 2015;4(10):637-40. 26673172]. [DOI:10.15171/ijhpm.2015.160] [PMID]
  8. Piroozi B, Moradi G, Esmail Nasab N, Ghasri H, Farshadi S, Farhadifar F. Evaluating the effect of health sector evolution plan on cesareanrate and the average costs paid by mothers: A case study in Kurdistan province between 2013-2015. J Hayat. 2016;22(3):245-54.
  9. Kim SJ, Han KT, Kim SJ, Park EC, Park HK. Impact of a diagnosis-related group payment system on cesarean section in Korea. Health Policy. 2016;120(6):596-603. [DOI:10.1016/j.healthpol.2016.04.018] [PMID]
  10. Gruber J, Kim J, Mayzlin D. Physician fees and procedure intensity: the case of cesarean delivery. J Health Econ. 1999;18(4):473-90. [DOI:10.1016/S0167-6296(99)00009-0]