• Masoud Behzadifar, Meysam Behzadifar, Mandana Saki, Mehrdad Valipour, Roodabeh Omidifar, Fatemeh Iranshahi, and Nicola Luigi Bragazzi.
• Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
• Int J Health Plann Manage. 2020 Jan 1; 35 (1): 339-345.

BackgroundThe high prevalence of cesarean section represents a major public health challenge worldwide. In 2014, the Iranian Health Transformation Plan (HTP) included programs promoting vaginal delivery.AimThe aim of this study was to investigate the effect of the HTP on the rate of cesarean section in Iran.MethodThe interrupted time series analysis (ITSA) was used. Cesarean section- and vaginal delivery-related monthly data were collected from eight public hospitals affiliated with the Lorestan University of Medical Sciences, from March 2012 to February 2019. The autocorrelation plots and the Durbin-Watson test were used for evaluating the autocorrelation between data points in the generalized least squares regression model.ResultsThe ITSA showed that the rate of cesarean section decreased immediately after the HTP, by -0.002 per 1000 persons (95% CI, -0.004 to -0.001; P = .069). After the HTP, a significant decreasing trend of cesarean section per month was computed (-0.003; 95% CI, -0.005 to 0.012; P = .043).ConclusionThe present study showed that the implementation of the HTP policy was effective in reducing the rate of cesarean section. This policy should continue, involving relevant stakeholders, raising mothers' awareness and motivation, and providing financial support.© 2019 John Wiley & Sons, Ltd.

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