{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:50:07Z","timestamp":1784033407065,"version":"3.55.0"},"reference-count":31,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T00:00:00Z","timestamp":1741737600000},"content-version":"unspecified","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"DOI":"10.13039\/100016195","name":"United Nations Development Programme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016195","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004421","name":"World Bank","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100004421","id-type":"DOI","asserted-by":"crossref"}]},{"name":"UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction"},{"DOI":"10.13039\/100006641","name":"UNICEF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006641","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["847567"],"award-info":[{"award-number":["847567"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100006661","name":"United Nations Population Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006661","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,2,3]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Objective: This study aimed to use the Robson Ten Group Classification System (TGCS) to assess caesarean section (CS) rates and other outcomes in eight referral hospitals in Burkina Faso before the implementation of non-clinical interventions to reduce unnecessary CSs.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Design<\/jats:title>\n<jats:p>This is a cross-sectional study.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Setting<\/jats:title>\n<jats:p>We conducted a 9-month prospective observational study on women who gave birth at eight referral hospitals in Burkina Faso between 1 April 2020 and 31 December 2020.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Participants<\/jats:title>\n<jats:p>We analysed 24 643 women who gave birth at the eight participating hospitals during the study period.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Outcomes measures<\/jats:title>\n<jats:p>We reported the relative size, CS rate and absolute contribution of each Robson group. These indicators were calculated for both referred and non-referred women. Oxytocin administration and stillbirth rates were calculated for women without previous CS and with a single fetus at cephalic presentation at term (groups 1\u20134).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Overall, 24\u2009643\u2009women gave birth at the eight participating hospitals during the 9-\u2009month study period. The overall CS rate was 30.6%. Women in spontaneous labour with a single fetus in the cephalic presentation at term without previous CS (groups 1 and 3) had high CS rates (26.5% and 15%, respectively), low oxytocin use (7.9% and 6.5%, respectively), and high stillbirth rates (3.4% and 3.9%, respectively). These subgroups of women were major contributors to the overall CS rate.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our results indicate that, in referral hospitals in Burkina Faso, the CS practice for referred women in groups 1 and 3 of the TGCS should receive special attention. These results also reveal areas for clinical improvement to reduce primary CS, especially in nulliparous women. The use of the TGCS is important in low-income countries where low CS rates at the population level may conceal suboptimal labour management in healthcare facilities.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Trial registeration number<\/jats:title>\n<jats:p>\n<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" xlink:href=\"ISRCTN67214403\">ISRCTN67214403<\/jats:ext-link>\n.\n<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/bmjopen-2024-086892","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T23:33:16Z","timestamp":1742254396000},"page":"e086892","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Can the Robson Ten Group Classification System improve the understanding of maternity care in low-income countries? A cross-sectional study in Burkina Faso"],"prefix":"10.1136","volume":"15","clinical-trial-number":[{"clinical-trial-number":"isrctn67214403","registry":"10.18810\/isrctn"},{"clinical-trial-number":"isrctn67214403","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8992-6971","authenticated-orcid":false,"given":"Charles","family":"Kabore","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Tiendrebeogo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5631-5883","authenticated-orcid":false,"given":"Ana Pilar","family":"Betran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Ravit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Robson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre","family":"Dumont","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"2025031313401190000_15.3.e086892.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0148343","article-title":"The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014","volume":"11","author":"Betr\u00e1n","year":"2016","journal-title":"PLoS One"},{"key":"2025031313401190000_15.3.e086892.2","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13526"},{"key":"2025031313401190000_15.3.e086892.3","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-3016.2007.00786.x"},{"key":"2025031313401190000_15.3.e086892.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1523-536X.2006.00118.x"},{"key":"2025031313401190000_15.3.e086892.5","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/EDE.0b013e318068646a","article-title":"Health Consequences of the Increasing Caesarean Section Rates","volume":"18","author":"Beliz\u00e1n","year":"2007","journal-title":"Epidemiology (Sunnyvale)"},{"key":"2025031313401190000_15.3.e086892.6","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/S0140-6736(05)76016-5","article-title":"Maternal mortality and mode of delivery","volume":"354","author":"Hall","year":"1999","journal-title":"The Lancet"},{"key":"2025031313401190000_15.3.e086892.7","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1016\/S0140-6736(06)68704-7","article-title":"Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America","volume":"367","author":"Villar","year":"2006","journal-title":"The Lancet"},{"key":"2025031313401190000_15.3.e086892.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.39363.706956.55"},{"key":"2025031313401190000_15.3.e086892.9","doi-asserted-by":"crossref","first-page":"e260","DOI":"10.1016\/S2214-109X(15)70094-X","article-title":"Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys","volume":"3","author":"Vogel","year":"2015","journal-title":"Lancet Glob Health"},{"key":"2025031313401190000_15.3.e086892.10","doi-asserted-by":"crossref","first-page":"53","DOI":"10.7196\/SAMJ.2016.v106i5.10821","article-title":"Maternal deaths from bleeding associated with caesarean delivery: A national emergency","volume":"106","author":"Fawcus","year":"2016","journal-title":"S Afr Med J"},{"key":"2025031313401190000_15.3.e086892.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-044383"},{"key":"2025031313401190000_15.3.e086892.12","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1016\/S0140-6736(18)31928-7","article-title":"Global epidemiology of use of and disparities in caesarean sections","volume":"392","author":"Boerma","year":"2018","journal-title":"The Lancet"},{"key":"2025031313401190000_15.3.e086892.13","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.k55","article-title":"Within country inequalities in caesarean section rates: observational study of 72 low and middle income countries","volume":"360","author":"Boatin","year":"2018","journal-title":"BMJ"},{"key":"2025031313401190000_15.3.e086892.14","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.13.117598"},{"key":"2025031313401190000_15.3.e086892.15","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0097769","article-title":"A systematic review of the Robson classification for caesarean section: what works, doesn\u2019t work and how to improve it","volume":"9","author":"Betr\u00e1n","year":"2014","journal-title":"PLoS One"},{"key":"2025031313401190000_15.3.e086892.16","unstructured":"World Health Organization . Robson classification: implementation manual, Geneva. 2017. Available: http:\/\/www.who.int\/reproductivehealth\/publications\/maternal_perinatal_health\/robson-classification\/en\/ [Accessed 03 Dec 2024]."},{"key":"2025031313401190000_15.3.e086892.17","doi-asserted-by":"crossref","DOI":"10.1186\/s13012-020-01029-4","article-title":"Implementation and evaluation of nonclinical interventions for appropriate use of cesarean section in low- and middle-income countries: protocol for a multisite hybrid effectiveness-implementation type III trial","volume":"15","author":"Dumont","year":"2020","journal-title":"Implement Sci"},{"key":"2025031313401190000_15.3.e086892.18","first-page":"ii30","article-title":"The national subsidy for deliveries and emergency obstetric care in Burkina Faso","volume":"26 Suppl 2","author":"Ridde","year":"2011","journal-title":"Health Policy Plan"},{"key":"2025031313401190000_15.3.e086892.19","unstructured":"Global Health Observatory . 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