Caesarean
section (C-section) considered as a public health problem, is one of the most
common surgeries in the world 1. The procedure is often performed without medical
need, hence putting women and their babies at risk of short- and long-term
health problems. Recently, it has been reported that the rates of C-section continue
to skyrocket, particularly in high- and middle-income countries 12. The international healthcare community considered
the ideal rate for cesarean sections to
be between 10% and 15% 12 3. On the hand, Malawi
follows the United Nations (UN) process indicators, which recommend that a
minimum of 5% and a maximum of 15% of all births should be delivered by
C-section 4. However, the World Health Organization (WHO)
underscores the importance of focusing on the needs of the patient and discourages
the practice of aiming for target rates 2. C-section may be necessary when vaginal delivery
might pose a risk to the mother or baby especially due to prolonged labor,
fetal distress, or because the baby is presenting in an abnormal position 13. Unfortunately, the procedure can cause significant problems,
disability or death, predominantly in settings that lack the facilities to
conduct safe surgeries or treat potential complications 23.

Previous
studies in many settings have reported that the causes of an increase in C-sections are multifactorial and poorly
understood 5. Notably, changes in maternal characteristics (i.e.
higher educational education, rise in maternal age, prior cesarean section, prolonged
labor, and increasing maternal Body Mass Index) 56, infant characteristics (i.e. baby weight – suspected
low infant birthweight or macrosomia, length of the baby) 67 and professional practice styles, increasing
malpractice pressure – private hospital status, as well as economic,
organizational, social and cultural factors have all been implicated in an increase in C-sections 5.

Cesarean section is one of the most important risk factors for postpartum maternal infection which
account for approximately 10% of pregnancy-related mortality and it carries a risk of infection 5 to 20 times that of vaginal
delivery 8910. It. In Malawi, since
1992, the rates of C-sections have been on the rise
as it was reported that only 3% of births occurred with C-section in 1992-2000
compared with 5% in 2010 and 6% in 2015-16 11. To the best of our
knowledge, few studies have until now been conducted to address the factors
that affect C-section in Malawi. For better results on C-sections, it is
necessary to contextualize the sociocultural determinants in addition to the
current healthcare model. Thus, the present study aimed to investigate the
associated factors of C-sections from
2004 to 2015 using the population-based
data.