Comparing Delivery Modes and Caesarean Section Indications Between Turkish Nationals and Syrian Refugees: A 7-Year, Large-Scale Retrospective Cohort Study

Emrah Göçer,1 Harika Göçer,1 Mehmet Genco,1 Merve Genco,2 Cemal Ünlü,3 Hüseyin Aksoy1 1Department of Obstetrics and Gynecology, Kayseri City Hospital, Kayseri, Türkiye; 2Department of Obstetrics and Gynecology, Kayseri State Hospital, Kayseri, Türkiye; 3Department of Obstetrics and Gynecology, Private Obstetrics and Gynecology Clinic, Kayseri, TürkiyeCorrespondence: Mehmet Genco, Department of Obstetrics and Gynecology, Kayseri City Hospital, Kayseri, Türkiye, Email [email protected]: To compare delivery modes, caesarean section (CS) rates, and CS indications between Turkish nationals and Syrian refugee women at a tertiary referral centre in Türkiye, and to evaluate temporal trends.Methods: This retrospective cohort study included 62,586 women delivering at Kayseri City Hospital between January 2019 and June 2025. Participants were categorised as Turkish nationals or Syrian refugees. Total CS rates, primary CS rates, annual delivery trends, and CS indications were compared using chi-square and independent-samples t-tests (p< 0.05).Results: Of the total population, 71% were Turkish nationals and 29% Syrian refugees. The overall CS rate was significantly higher among Turkish women (48% vs. 29%, p< 0.001). Primary CS rates were also higher in Turkish women (17% vs. 9%, p< 0.001), while vaginal delivery was more frequent among Syrian women (71% vs. 52%). Turkish women were significantly older on average; gestational age, fetal sex, and birth weight were broadly comparable between groups. In both populations, repeat caesarean section or previous uterine surgery was the most common CS indication. Among primary CS cases, fetal presentation and positional anomalies were the leading indications. Primary CS rates showed a significant temporal decline in both groups across the study period.Conclusion: Syrian refugee women demonstrated markedly lower total and primary CS rates compared with Turkish nationals. These findings should be interpreted cautiously given the retrospective single-centre design and the absence of key confounders, including parity and body mass index. Prospective studies incorporating multivariable analyses are warranted to elucidate the determinants of these disparities.Keywords: caesarean section, mode of delivery, refugee health, syrian refugees, migrant women, obstetric outcomes, Türkiye