The QUALI-DEC project :

guiding you in your choices

Of the 30 million Caesarean sections performed worldwide in 2015, 12 million (40%) are probably unnecessary. This excess of caesarean sections mainly affects highly populated countries with a practice of caesarean section exceeding 15% of deliveries, such as China, Brazil, Egypt or the United States. In addition to this abuse of Caesarean sections, other countries have a total deficit of 2 million Caesarean sections. There is an urgent need to put in place effective strategies to reduce these disparities by guaranteeing access to Caesarean sections for all women who need them, while at the same time not tipping the deficit to excess.

Source: Dumont A, Guilmoto CZ, “Too much and not enough at once: the double burden of Caesarean section”, Population & Societies, 2020/9 (No. 581), p. 1-4. DOI: 10.3917/popsoc.581.0001.

The objectives of the QUALI-DEC project:

to improve the quality of caesarean section decisions

The over-use of caesarean sections can no longer be seen solely as the result of inappropriate clinical practices. Non-clinical factors, such as social, cultural and structural influence, have emerged as important potential factors and need to be taken into account in order to effectively address this problem.

Non-clinical interventions have been shown (mainly in high-income countries) to reduce Caesarean section rates, such as decision support or having a family member accompany the woman during childbirth.

The QUALI-DEC strategy and tools:

Based on the recommendations of the World Health Organization (WHO) and scientific studies, our strategy consists of four components aimed at reducing non-medically justified Caesarean sections.

– The use of opinion leaders to encourage evidence-based clinical practice.

– Review of caesarean section indications by the caregivers themselves with feedback to the whole team (audit & feedback) to avoid unnecessary interventions.

– Support by a relative to reassure the woman during labour.

– A decision support tool to encourage dialogue between caregivers and women during pregnancy monitoring.

Components of the intervention

Audit & Feedback

Evaluation of caesarean section indications by the clinicians themselves in order to improve their practice and future decisions.


Better support from family and friends to reduce anxiety and fears of vaginal birth.

Opinion leaders

Respected clinicians in their hospitals in charge of encouraging evidence-based clinical practice.

Decision analysis tool

A decision analysis tool strengthens the dialogue between the health worker and the pregnant woman to discuss the woman's reasons for choosing one of the two modes of delivery.