{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:58:12Z","timestamp":1779238692244,"version":"3.51.4"},"reference-count":70,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,11,28]]},"abstract":"<jats:p>Background: Caesarean section (CS) rates have been reported to differ between immigrants and native-born women in high-income countries.<\/jats:p>\n                  <jats:p>Objective: We assessed the CS rate and its relationship with the CS rate in country of nationality and other explanatory factors among women of different nationalities including Qatari women who underwent deliveries at our hospital to generate evidence that will quantify and help explain the observed CS rates in our hospital.<\/jats:p>\n                  <jats:p>Methods: In this retrospective cross-sectional study conducted at the second-largest public maternity hospital in Qatar, Al-Wakra Hospital (AWH), data for all births delivered in 2019 were retrieved from the hospital's electronic medical records. The CS rates and the crude and adjusted risks of Caesarean delivery for mothers from each nationality were determined, and the common indications for CS were analyzed based on nationality. The association between nationality and Caesarean delivery was examined using binomial logistic regression analysis, with Qatari women as the reference group. The correlation between CS rate in country of nationality and observed CS rates in Qatar was also examined using Pearson's correlation.<\/jats:p>\n                  <jats:p>Results: The study population consisted of 4816 births by women of 68 nationalities, of which 4513 births were by women from 25 countries. The highest proportion of deliveries (n-1247, 25.9%) was by Indian women. The frequency of CS was the highest and lowest among Egyptian (49.6%) and Yemeni women (17.9%), respectively. Elective CS was predominantly performed in women of Arab nationalities; the most common indication was a history of previous multiple CSs. Emergency CS was primarily performed in women of Asian and Sub-Saharan African nationalities; the most common indications were failure to progress and fetal distress. For most nationalities, the CS rate in Qatar was associated with those of the countries of nationality.<\/jats:p>\n                  <jats:p>Conclusions: The observed CS rates varied widely among women of different nationalities. The variation was influenced by maternal factors and medical indications as well as the CS rates in the country of nationality. We posit that cultural preferences, acculturation, and patient expectations influenced observed findings. More efforts are required to reduce primary CS rates and to help women make the most informed decisions regarding modes of delivery.<\/jats:p>\n                  <jats:p>Key Message: CS rates varied widely among women of different nationalities. The variation was influenced by medical indications, maternal preferences, and CS rate in countries of nationality. The solution to reducing CS rates should be a culturally informed response.<\/jats:p>","DOI":"10.5339\/qmj.2021.69","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T02:30:47Z","timestamp":1638239447000},"source":"Crossref","is-referenced-by-count":4,"title":["Impact of maternal nationality on caesarean section rate variation in a high-income country"],"prefix":"10.5339","volume":"2021","author":[{"given":"Saheed","family":"Shittu","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Al-Wakra Hospital, Hamad Medical Corporation, Qatar E-mail: SShittu@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lolwa","family":"Alansari","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Al-Wakra Hospital, Hamad Medical Corporation, Qatar E-mail: SShittu@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahed","family":"Nattouf","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Al-Wakra Hospital, Hamad Medical Corporation, Qatar E-mail: SShittu@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tawa","family":"Olukade","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Hamad General Hospital, Hamad Medical Corporation, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naji","family":"Abdallah","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology, Al-Wakra Hospital, Hamad Medical Corporation, Qatar E-mail: SShittu@hamad.qa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3277","reference":[{"issue":"360:","key":"CIT0001","series-title":"BMJ","article-title":"Within country inequalities in Caesarean section rates: observational study of 72 low and middle income countries","year":"2018;"},{"issue":"(10155):","key":"CIT0002","series-title":"Lancet","first-page":"1341\u20131348","article-title":"Global epidemiology of use of and disparities in Caesarean sections","volume":"392","year":"2018;"},{"issue":"(10155):","key":"CIT0003","series-title":"Lancet","first-page":"1349\u20131357","article-title":"Short-term and long-term effects of Caesarean section on the health of women and children","volume":"392","year":"2018 Oct 13;"},{"issue":"(1):","key":"CIT0004","series-title":"PLoS Med","first-page":"e1002494","article-title":"Long-term risks and benefits associated with Caesarean delivery for mother, baby, and subsequent pregnancies: systematic review and meta-analysis","volume":"15","year":"2018;"},{"issue":"(4):","key":"CIT0005","series-title":"Epidemiology","first-page":"485\u20136","article-title":"Health consequences of the increasing Caesarean section rates","volume":"18","year":"2007 Jul;"},{"issue":"(1):","key":"CIT0006","series-title":"BMC Pregnancy Childbirth","first-page":"2","article-title":"Factors contributing to rapidly increasing rates of Caesarean section in Armenia: a partially mixed concurrent quantitative-qualitative equal status study","volume":"19","year":"2019;"},{"issue":"(10155):","key":"CIT0007","series-title":"Lancet","first-page":"1279","article-title":"Stemming the global Caesarean section epidemic","volume":"392","year":"2018 Oct 13;"},{"issue":"79:","key":"CIT0008","series-title":"Acta Obs Gynecol Scand","first-page":"553\u20138","article-title":"Caesarean section among immigrants in Norway","year":"2000;"},{"key":"CIT0009","article-title":"Health at a Glance 2011: OECD Indicators"},{"issue":"12:","key":"CIT0010","series-title":"Reprod Health","first-page":"57","article-title":"What is the optimal rate of Caesarean section at population level? 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