Scoping Review of Non-Clinical Factors Influencing Elective Cesarean Section Preference Among Pregnant Women in Iran

Background: In Iran, the existence of the knowledge-practice paradox in the field of childbirth has become a complex challenge, and despite the relative and increasing awareness of the society, especially women, of the benefits of natural childbirth and the potential complications of cesarean section, the desire for elective and planned cesarean section remains high. This study aimed to investigate in depth the non-clinical factors of this gap between knowledge and choice. Methods: This study was conducted as a scoping review based on the methodological framework (Arksey & O'Malley) and in accordance with the PRISMA-ScR guidelines. A systematic search was conducted in PubMed, Scopus, and Web of Science databases. keywords “elective cesarean section”, “maternal preference”, “non-clinical factors”, “culture” and “Iran” between the years ۲۰۰۰ and ۲۰۲۴. Inclusion criteria were studies that explicitly examined psychological, social, cultural, or economic dimensions influencing the desire or preference for cesarean section. Data were analyzed using thematic synthesis. Findings: From the eligible studies, four powerful key axes of nonclinical factors were extracted that often override mere knowledge: ۱) Cultural-symbolic factors: cesarean section has been redefined as a “symbolic commodity” that carries connotations of modernity, control, well-being, and even higher social status. ۲) Psycho-identity factors: Deep and multidimensional fears (not only of pain, but also of loss of control, damage to bodily identity, and sexual function) and avoidance of the inherent uncertainty of vaginal birth are the main motivations. ۳) Relational-influence factors: The catalytic role of the physician—sometimes influenced by time constraints, fear of lawsuits, or economic considerations—and the normative pressure of family and peer networks influence the individual’s decision. ۴) Structural-incentive factors: The alignment of economic interests of some parts of the health system with performing cesarean section and the ease of management and planning for

کلیدواژه ها:

elective cesarean section ، maternal preference ، non-clinical factors ، culture ، Iran