Cesarean Section Rates before and after the Implementation of Health Sector Evolution Plan in Iran: An Interrupted Time Series Analysis

Introduction: Today, the issue that is challenging cesarean delivery is its overuse as the conventional method of birth in the world, especially in developing countries. The Iranian health system implemented the Health Sector Evolution Plan (HSEP) in 2014 to reduce CS rates. Objective: The objective of the study was to evaluate the effect of the implementation of the HSEP on the rate of CS in an Iranian subpopulation (Qom province) in 13 years. Methods: In this longitudinal retrospective study, the trend of CS rate over 13 years (2005-2017) in Qom province has been studied by using an interrupted time series analysis. Results: In the period after implementation of the HSEP, the rate of CS decreases by 0.1% monthly compared to the previous period, which was not statistically significant. This trend is more definite among governmental hospitals. In contrast, the pattern observed in non-governmental hospitals has a monthly increased trend. Conclusion: After more than four years of implementation of the HSEP, it has not been able to significantly reduce the overall CSs during this period in Qom province and has failed to reach the plan's goals.