Factors associated with caesarean section preference and request in the Middle East: a scoping review

Abstract Background Caesarean section (CS) rates in the Middle East are among the highest worldwide, with several countries reporting rates between 35% and 55%. WHO has observed that population-level rates above approximately 10% are not associated with further reductions in maternal and newborn mortality and does not recommend a specific target rate. Women’s preference for, and request of, caesarean delivery may contribute to these rates. Because few regional studies isolate caesarean delivery on maternal request (CDMR), this review maps factors associated with caesarean preference and request broadly (preference, intention, documented request, elective delivery), not determinants of caesarean section without medical indication; no previous scoping review has done so. Methods This review followed the Arksey and O’Malley framework and was reported in accordance with PRISMA-ScR. We searched PubMed, Semantic Scholar, and CINAHL from January to March 2026 and again on 28 September 2026, adding Israel and broader request-related terms. After two-stage screening, we included 58 studies. Data were extracted using a structured form and synthesized thematically; theme frequencies indicate how often a factor was reported, not its strength. Results The 58 studies (2015–2026) were conducted in ten Middle Eastern countries and included at least 19,644 participants and about 1.5 million birth records. Iran contributed the largest share (41%). Seven themes were identified by reporting frequency: (1) fear of childbirth and pain (64% of studies), (2) social and cultural influences (38%), (3) previous CS experience (29%), (4) healthcare system and physician factors (41%), (5) sociodemographic factors (43%), (6) perceived CS safety and concerns about bodily integrity (45%), and (7) psychological factors (17%). In one Saudi study, non-Saudi nationality and higher income were associated with CS preference after adjustment (a preliminary finding). Conclusions The mapped evidence suggests that caesarean preference and request in the Middle East are associated with personal fears, social and cultural factors, healthcare-system factors, and socio-demographic factors. No included study described antenatal fear-of-childbirth screening, although the absence of reporting does not establish the absence of practice. Because the evidence is mainly cross-sectional or qualitative and was not critically appraised, these findings should first guide primary research, particularly in underrepresented countries. Review registration Not registered.