Factors associated with caesarean section among primiparous women at a tertiary hospital in Afghanistan

Caesarean section (CS) is a life-saving intervention when medically indicated; however, both underuse and overuse remain major concerns, particularly in low-resource settings, including Afghanistan. The objective of the study is to determine the CS delivery rate and identify maternal and clinical factors associated with CS delivery among primiparous women at a private tertiary referral hospital in Kabul, Afghanistan. A hospital-based cross-sectional study was conducted among all eligible primiparous women who delivered at a tertiary hospital in Kabul, Afghanistan, between January 2025 and March 2026, and 990 consecutive records met the eligibility criteria and were included in the analysis. Data were extracted from delivery registry records using a structured checklist. Bivariable analysis using chi-square tests and multivariable logistic regression were performed to identify factors associated with CS. Out of 990 deliveries, 34.9% were CS. The odds of CS were lower in women aged < 20 years (AOR = 0.17, 95% CI 0.06–0.52), those aged 20–29 years (AOR = 0.29, 95% CI 0.10–0.82), and in women with pre-term (AOR = 0.50, 95% CI 0.25–0.90) and term (AOR = 0.45, 95% CI 0.27–0.77) pregnancy. On the other hand, mal-presentation (AOR = 15.55, 95% CI 8.10–29.85), fetal distress (AOR = 13.25, 95% CI 8.14–21.55), hypertensive disorders (AOR = 2.15, 95% CI 1.34–3.44), oligohydramnios (AOR = 1.93, 95% CI 1.13–3.29), and multiple pregnancies (AOR = 3.79, 95% CI 1.82–7.90) were independently associated with increased odds of CS. More than one-third of primiparous women had CS, and it was independently associated with maternal age, gestational age, hypertensive disorders, fetal distress, mal-presentation, oligohydramnios, and multiple pregnancy. Future multicentre studies are warranted to evaluate factors associated with CS in more representative populations across Afghanistan.