The impact of Health Transformation Plan on natural vaginal delivery and cesarean section frequency in Iran: an interrupted time series analysis

OBJECTIVE: This study was conducted to evaluate the effect of the Iran’s Health Transformation Plan on the frequency of natural vaginal deliveries (NVDs), cesarean sections (CSs), and total deliveries in the Fars province of Iran. RESULTS: Average number of total deliveries before and after the reform were 3946 and 3810, respectively (p = 0.164). The ratio of CS to total deliveries in the first study month was 54%. This rate reached 47% in the last month (p < 0.01). However, it had much fluctuation trend. The ITSA results showed that in the short-run, the NVD rate increased (β = 492.79, p < 0.01), the rate of CS decreased (β = − 407.09, p < 0.01), and total deliveries increased (β = 85.75, p < 0.724). However, in the long-run, the NVD (β = 5.74, p < 0.423), CS (β = 10.21, p < 0.189), and total deliveries (β = 15.96, p < 0.256) had no significant changes after the reform. Encouraging the NVD package was influential in the short-run but not in the longrun in Iran. Pricing and supply-side policies could not reduce the rate of non-clinical CS on their own. Therefore, paying attention to demand-side policies and changes in consumer behaviors, such as educating the women at the age of pregnancy about the advantages and disadvantages of CS and NVD and correcting misconceptions, could be helpful.