Perspectives of obstetricians and midwives on the preference for caesarean deliveries: a qualitative exploration in Andhra Pradesh, India.

INTRODUCTION: Caesarean section rates in Andhra Pradesh increased to 42.4% in 2019-21, far above the WHO-recommended 10-15% level. Although the c-sections are life-saving when medically necessary, their overuse is a cause of concern for maternal health outcomes and increased health expenditure. The present study aims to understand the perceptions of obstetricians and midwives on the rising trend of preference for caesarean sections in the selected districts of Andhra Pradesh. MATERIALS AND METHODS: A phenomenological qualitative research design was adopted for this study, conducted among four districts of Andhra Pradesh: two with high C-section rates (Visakhapatnam, Krishna) and two with low C-section rates (Anantapur, Chittoor). Sixteen in-depth interviews were conducted with eight obstetricians and eight midwives selected through purposive sampling. Interviews were recorded digitally and transcribed verbatim, and Braun & Clarke's thematic analysis framework was employed to generate the themes and sub-themes. RESULTS: Thematic analysis of the obtained data revealed four major themes influencing the preference for caesarean sections, which included: Sociocultural and psychological determinants, including tokophobia, family pressures, and beliefs about auspicious dates of birth; followed by Maternal and lifestyle determinants, including sedentary behaviours that affect physiological capacity for vaginal delivery and mothers' decisions based on convenience. In addition, Healthcare system factors, including time, medico-legal considerations, staffing issues, and Medical indications for C-sections, including high-risk pregnancy and labour complications. These results suggest that the decision to conduct c-sections was influenced not only by medical indications but also by societal, systemic, and individual-level factors. CONCLUSION: The study highlights that while medical indications are a valid basis for conducting c-sections, a substantial proportion of c-sections are happening due to the influence of non-clinical factors such as socio-cultural beliefs, maternal preferences, systemic challenges and provider convenience. The findings emphasize the need for a comprehensive regulatory framework, with standard clinical protocols, periodic audits, and maternal education, to reduce unnecessary c-sections in Andhra Pradesh.