Reducing maternal mortality in LMICs through free caesarean deliveries: a narrative review of challenges and solutions

Caesarean section (CS) is an essential life-saving intervention for the management of obstetric complications that endanger maternal and neonatal health. Despite the World Health Organization’s recommendation of a 10–15% caesarean section rate to minimize maternal and neonatal mortality, access to timely caesarean deliveries remains a significant challenge in low- and middle-income countries (LMICs). Financial barriers and resource limitations prevent the widespread use of caesarean section in LMICs, contributing to high maternal mortality rates. In response, some LMICs have implemented free or subsidised CS programmes to improve maternal health outcomes. This narrative review assesses the impact of these free CS programmes on maternal mortality, highlighting ongoing successes and challenges. Evidence suggests that free CS initiatives can reduce maternal mortality, particularly when financial and logistical support is strong. However, disparities in health infrastructure, limited trained personnel and cultural barriers continue to limit the effectiveness of these programs. Key challenges include the financial sustainability of free CS services, the lack of trained professionals, geographic and cultural barriers to access to care, inadequate preoperative and post-operative support, and ineffective government policy. Opportunities to improve access include promoting partnerships between governments, NGOs and international organizations, investing in health infrastructure, particularly in rural areas, and strengthening community education to combat cultural resistance. The review highlights the need for robust monitoring and evaluation frameworks to track the impact of free caesarean section programs on maternal mortality. Strengthening these programs through sustainable funding, improved targeted policies and community engagement is essential to expand access to safe and equitable maternal health care in low- and middle-income countries.