Axe 1 - Santé et Genre

QUALI-DEC Appropriate use of Caesarean section through QUALIty DECision-making by women and providers

Responsable scientifique

Membres du Ceped




Overuse of caesarean section (C-section) has adverse consequences on maternal and child health. It also deviates essential resources worldwide and hinders universal access to healthcare services. We aim to develop and evaluate a strategy to implement non-clinical interventions to reduce unnecessary C-sections in Argentina, Burkina Faso, Thailand and Vietnam.

This strategy combines four active ingredients : opinion leaders to implement evidence-based clinical guidelines, caesarean audits and feedback to help providers identify potentially avoidable C-sections, a decision-analysis tool to empower women for better decision-making on mode of delivery, and the implementation of WHO recommendations on companionship during labour to support women during vaginal birth. The project promotes the engagement of stakeholders at all levels (policy-makers, health providers and end-users i.e. women) from the very start of the project to implement intervention components, which take into account the local context and to ensure a maximisation of the expected impacts. To improve the quality of implementation and use of evidence, knowledge transfer activities will be implemented. Qualitative and health systems research to investigate the multiple layers of power and interaction as well as decision-making processes within multi-professional teams are integrated throughout the project in order to bridge the knowledge-do gap and better understand scaling-up processes. The evaluation will examine physical and psycho-social effects of the strategy and will highlight the interdependent relationship between maternal and child outcomes related to overuse of C-section. Particular attention will be given to equity issues and gender considerations in the interpretation of results. Overall, our project will improve appropriate use of C-sections and will address several SDG targets including improving maternal and neonatal health and reducing inequalities within and between countries.


Présentation du projet sur Youtube


Caesarean, non-clinical interventions, formative research, clinical guidelines, knowledge-do gap, decision-making, companionship, women, health organisations, gender, inequity, knowledge broker

Zones géographiques

Argentine, Burkina Faso, Thaïlande, Vietnam


  • 2020-2025


Notes de politique - Policy Brief

Labour Companion in Thailand
Robson classification Argentine



  • Dumont Alexandre, de Loenzien Myriam, Nhu Hung Mac Quo, Dugas Marylène, Kabore Charles, Lumbiganon Pisake, Torloni Maria Regina, Gialdini Celina, Carroli Guillermo, Hanson Claudia, Betrán Ana Pilar et On behalf of the QUALI-DEC consortium (2022) « Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low- and middle-income countries », éd. par Melissa Morgan Medvedev, PLOS Global Public Health, 2 (11) (novembre 14), p. e0001264. DOI : 10.1371/journal.pgph.0001264.
    Résumé : Women’s fear and uncertainty about vaginal delivery and lack of empowerment in decision-making generate decision conflict and is one of the main determinants of high caesarean section rates in low- and middle-income countries (LMICs). This study aims to develop a decision analysis tool (DAT) to help pregnant women make an informed choice about the planned mode of delivery and to evaluate its acceptability in Vietnam, Thailand, Argentina, and Burkina Faso. The DAT targets low-risk pregnant women with a healthy, singleton foetus, without any medical or obstetric disorder, no previous caesarean scarring, and eligibility for labour trials. We conducted a systematic review to determine the short- and long-term maternal and offspring risks and benefits of planned caesarean section compared to planned vaginal delivery. We carried out individual interviews and focus group discussions with key informants to capture informational needs for decision-making, and to assess the acceptability of the DAT in participating hospitals. The DAT meets 20 of the 22 Patient Decision Aid Standards for decision support. It includes low- to moderate-certainty evidence-based information on the risks and benefits of both modes of birth, and helps pregnant women clarify their personal values. It has been well accepted by women and health care providers. Adaptations have been made in each country to fit the context and to facilitate its implementation in current practice, including the development of an App. DAT is a simple method to improve communication and facilitate shared decision-making for planned modes of birth. It is expected to build trust and foster more effective, satisfactory dialogue between pregnant women and providers. It can be easily adapted and updated as new evidence emerges. We encourage further studies in LMICs to assess the impact of DAT on quality decision-making for the appropriate use of caesarean section in these settings.
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