• Trends of prevalence and costs of natural childbirth in Mashhad hospitals before and after Iran health sector reforms
  • Elaheh Askarzadeh,1 Amin Adel ,2 Akbar Javan Biparva ,3 Saeed Husseini Barghazan,4,*
    1. Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
    2. Health Services Management, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
    3. Health Services Management, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
    4. Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.


  • Introduction: The guidelines for the promotion of natural childbirth have been communicated and implemented with the aim of promoting maternal and neonatal health indicators within the framework of recent health system reform plans. We aimed to analysis trends of prevalence and costs of natural childbirth in Mashhad hospitals before and after Iran health sector reforms.
  • Methods: This is a cross-sectional and retrospective descriptive study. The statistical population of the study consisted of all women who referred for the sake of natural and cesarean section to Mashhad hospitals (private and public) from May 15, 2013 to May 15, 2015. Required data were collected using a researcher-made checklist based on hospital records system. Data were analyzed by SPSS software.
  • Results: The prevalence of natural childbirth in 2013 was 46% (52698 cases), which increased to 53% (64346 cases) within a year after the implementation of the health care reforms (p-value less than 0.05). In the 2013, patient out of pocket payment for natural childbirth (in the public sector) was 22% of the all payments, which decreased to 2% in the year 2015.
  • Conclusion: Given the more serious consequences of cesarean delivery than natural childbirth, it seems that the in the case of promoting culture of natural childbirth, create financial incentives for maternity and care providers and the reduction of patient payments, the Health care reforms has succeeded in promoting natural childbirth in health system especially in public hospitals.
  • Keywords: health care reforms, natural childbirth, out of pocket payment.