The policy environment encouraging C-section in Lebanon.
OBJECTIVE
This study aims to analyse the environment encouraging C-section in Lebanon and to reveal approaches that could be adopted for the reduction of this practice, by considering the attitudes, opinions and actions of different stakeholders.


METHODS
Semi-structured interviews were conducted with 20 selected key players, including hospital directors, midwives, insurance bodies, syndicates and scientific societies, ministries, international agencies, medical schools, media representatives and women's groups. In addition, a group discussion was conducted with 10 obstetricians. Semi-structured interviews were conducted with a convenience sample of 36 women who had a C-section within 4 months preceding the study. Data was analysed using the Policy Maker software version 2.3.


RESULTS
Findings of the study point to the role of multiple factors in shaping the current practices related to C-section deliveries, among which are the organisation of the health care system, the dominance of the private sector, the lack of physician accountability, the minimisation of midwives' roles in the process and women's misconceptions about C-sections.


CONCLUSIONS
Involvement of the diversity of players is important to change practices in maternity care in Lebanon, after considering their position and power. Different strategies making use of available opportunities to improve the current situation are discussed.