Caesarean section (C-section) considered as a public health problem, is one of the most common surgeries in the world. The procedure is often performed without medical need, thus putting women and their neonates at risk of short- and long-term health problems 1. Recent reports have suggested 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% 123.

The Malawi government follows the United Nations (UN) 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 poses a risk to the mother or neonate particularly due to fetal distress, prolonged labor, or because the baby is presenting in an abnormal position 13. Unfortunately, the procedure can lead to significant problems, disability or death, predominantly in settings that lack the facilities to conduct safe surgeries or treat potential complications 23.

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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.

C-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. 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. For better results on C-section, it is necessary to contextualize the sociocultural determinants. Thus, the present study aimed to investigate the associated factors of C-sections from 2004 to 2015 using the population-based data.