Perception of Caesarean Section in Lower Middle-Income Countries: A Narrative Review

Background: Caesarean section (CS) is an essential intervention that reduces maternal and neonatal morbidity and mortality when medically indicated. However, perceptions of caesarean delivery among women, families, communities, and healthcare providers in lower middle-income countries (LMICs) are shaped by cultural beliefs, socioeconomic conditions, healthcare experiences, and availability of resources. These perceptions influence acceptance, utilization, and decision-making regarding mode of delivery.Aim: This narrative review examines perceptions of caesarean delivery in LMICs, exploring factors influencing acceptance or refusal, sociocultural beliefs, experiences of women, healthcare provider perspectives, and implications for maternal health services.Method: A narrative review of published literature was conducted using electronic databases including PubMed, Scopus, and Google Scholar. Relevant studies addressing perceptions, attitudes, beliefs, experiences, and decision-making regarding caesarean delivery in LMICs were reviewed. Studies involving pregnant and postpartum women with their significant others, families, communities, and healthcare providers were included.Results: Perceptions of caesarean delivery in LMICs are complex and vary between settings. While many women recognize CS as a life-saving procedure, others perceive it as unnatural, dangerous, expensive, or associated with social stigma. Fear of pain, death, infertility, poor recovery, and inability to perform domestic roles contributes to negative attitudes. Conversely, previous positive experiences, improved education, counselling, and respectful maternity care increase acceptance. Healthcare system factors, including provider communication, cost, and access to emergency services, strongly influence perceptions.Conclusion: Improving perceptions of caesarean delivery in LMICs requires culturally sensitive education, respectful maternity care, improved communication, and equitable access to safe surgical services. Addressing misconceptions while respecting women’s preferences is essential for reducing preventable maternal and neonatal complications.