QUALI-DEC is a research project aimed at designing and evaluating a strategy to implementing non-clinical interventions targeted simultaneously at clinicians, women and health organizations to reduce unnecessary C-sections in Argentina, Burkina Faso, Thailand and Vietnam. Despite long-lasting international concern and debate, the proportion of births by caesarean section (C-section) continues to increase. This trend is not confined to high-income countries, but it widely affects low-and middle-income countries (LMIC). When medically indicated, a caesarean can effectively prevent maternal and perinatal mortality and morbidity; however there is no evidence of the benefits of a caesarean delivery for women and infants who do not need the procedure1-3As with any surgery, a C-section has short-and long-term risks that can even affect future pregnancies. These risks are higher and more severe in low-resource settings that lack the capacity to conduct safe surgery or treat surgical complications5. Particularly in low-but also in middle-income countries, overuse and underuse of C-section co-exist, widening health inequalities and further weakening health systems in these countries6. Overuse of C-sections can no longer be seen only as the result of inappropriate clinical practices during labour. Non-clinical factors such as social, cultural and organisational influences have emerged as potential drivers and need to be considered to effectively tackle this growing issue7Non-clinical interventions have been shown to safely reduce C-section rates, predominantly in high-income settings8. These interventions are applied independently of patient care in aclinical encounter, and they may target clinicians who are involved in caesarean decision-making (doctors and midwives), women and families, or healthcare organizations or facilities. Among interventions targeted at clinicians, implementation of guidelines combined with audit and feedback as well as physician education by local opinion leaders are the most promising strategies.