Iran’s Struggling Health System: An Increase in Natural Childbirth: A Case Study

Abstract

Background: The 7th package of health reform in Iran has been implemented in May 15, 1393, is concerned with the “promotion of natural childbirth.” It has been focusing on reducing cesarean section (CS) and promoting normal vaginal delivery (NVD) as broadly as possible. This study
evaluated the changes in the vaginal delivery and cesarean before and after implementation of the 7th package of health reform in public and private hospitals of Isfahan Province in 2014.

Methods: This was a quasi‑experimental research. The population of this study contained all public and private hospitals in Isfahan Province covered by the Health Reform Program. It included 22 public and 6 private hospitals. The data collected from the vice chancellor of treatment in 6 months before and after the implementation of the program have been analyzed. SPSS software version 18.0 (SPSS Inc., Chicago, IL, USA) and independent t‑test have been employed for data analysis.

Results: It was demonstrated that the increasing rate of NVD (P = 0.001) and decreasing rate of CS in public hospitals (P = 0.027) after the implementation of the plan were signifcant. On the other hand, the increasing rate of CS in private hospitals was signifcant (P = 0.026).

Conclusions: Although this scheme has achieved its targets in public hospitals of Isfahan Province, it has not met its objectives in private hospitals. It seems CS operations were shifted from public hospitals to
private ones, which is conflict with the objectives of the health reform plan.

Keywords: Cesarean section, health reform, Iran, Isfahan, normal vaginal delivery