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Background & Aim: Cesarean section (CS) rate was 56% in 2012 in Iran, which was considerably higher than the WHO recommended rate (10-15%). Thus, the Normal Delivery Promotion (NDP) program as a part of Iran’s Health Transformation Plan (HTP) was implemented in 2014 to reduce unnecessary cesarean deliveries and promote maternal and neonatal health. The aim of the study was to evaluate the effect of the NDP plan on the CS rates.
Methods & Materials: This quasi-experimental and longitudinal study analyzed the immediate and long- term effects of the NDP program on the CS trend in Iran using an interrupted time series analysis. Monthly CS rates in the hospitals of the country were extracted from April 2013 to September 2018.
Results: Overall CS rate in Iran decreased by 6% immediately after the implementation of the NDP program and then remained at the same level. The NDP program reduced the CS rate in teaching (9.5%), non-teaching (11.7%), private (18.1%), and charity (27.1%) hospitals. But the CS rate increased in social security (7%) and other hospitals (15.7%). The CS rate would have reached 58.5% by September 2018 if the NDP program had not been implemented.
Conclusion: The NDP program was somewhat effective in reducing the CS rate in Iran. Promoting this program by formulating a strategic plan and comprehensive action plans addressing various underlying causes of CS at meta (ministry of health), macro (universities of medical sciences), meso (hospitals) and micro (obstetricians, midwives, and mothers) levels and considering effective solutions in the areas of governance and leadership, financing, human resources, equipment, information and service delivery is critical to achieve the determined national goals.
 

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The COVID-19 pandemic has damaged the lives of many people physically, psychologically, and socio-economically, and put a lot of pressure on the health system. COVID-19 infected 628.3 million people and killed 6.6 million people in the world until November 3, 2022 (1). The pandemic has exposed vast economic and social inequalities and widened the existing gap in providing services for the most vulnerable people, including women and girls. Preliminary studies show that COVID-19 disease affects men more than women. The death rate of men infected with COVID-19 is about 60 to 80% higher than that of women (2). However, as the prevalence and duration of the disease increases, its effects on women become increasingly severe. This disease undermined the fundamental rights of women and girls. They suffer disproportionately from discrimination, neglect and abuse. The World Economic Forum estimated in 2021 that the global gender gap would take about 36 years to close after the COVID-19 pandemic (3).
Women make up about 70% of healthcare workers (4). Therefore, they are at higher risk of contracting the COVID-19 infection. Also, quarantine measures have led to deficiencies in sexual, reproductive and maternal health care, increased domestic violence, the increased workload of girls and women at home and their withdrawal from schools, universities and the labor market. In other words, the secondary effects of COVID-19 threaten the health and lives of women and girls.