first birth cesarean proportion: a missed indicator in controlling policies

background: around one out of two mothers give births by cesarean section (cs) surgery in iran and about half of this number is due to previous cs. recently health sector evolution (hsep) program (started in april 2014) targets the high rate of cs in iran. to assess the impact of the interventions, we emphasized that the first birth cesarean (fbc) proportion is one of the main indicators to assess the controlling programs.   methods: data on the mode of delivery were collected in kerman province between 21 march and 20 march 2015 classified by hospital ownership. fbc proportion is defined as the number of cs in the first pregnancies divided by the total number of first births. chi-square test for trend was used to assess the trends.   results: total number of births was around 34000. there were 8.9 and 13.1 percent reduction in cs and fbc proportion respectively. cs proportion was 54.5 at the end of the first quarter of the studied period and reached to 49.6 at the end of the period (p< 0.0001). also, fbc proportion was 54.1 percent at first and reached to 47 percent at the end of the study period. the main reason for cs was due to previous cs. at the hospital level, the highest reduction in cs and fbc proportion were in public hospitals.   conclusion: results suggested more reduction in fbc proportion than the cs proportion, so this is a very good sign since more potential cs cases will be prevented. as repeated cs is one of the main indications for the operation, in the short term, even effective policies may change the overall proportion slightly, while the fbc proportion is more sensitive to reflect the impacts. therefore, it is necessary to target the main fuel to reduce cs proportion effectively.