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Lessons from a multidisciplinary partnership involving women parliamentarians to address the overuse of caesarean section in Italy
  1. Pilar Montilla1,
  2. Francesca Merzagora2,
  3. Elisa Scolaro3,
  4. Jennifer Requejo4,
  5. Walter Ricciardi5,
  6. Elena Meli6,
  7. Adriana Bazzi7,
  8. Giorgio Vittori8,
  9. Flavia Bustreo9,
  10. Rosanna Boldi10,
  11. Maria Rizzoti11,
  12. Mario Merialdi12,
  13. Ana Pilar Betran3
  1. 1Fondazione Cardiocentro Ticino, Lugano, Switzerland
  2. 2Osservatorio Nazionale sulla Salute della Donna e di Genere, Milan, Italy
  3. 3Reproductive Health and Research, World Health Organization, Geneva, Switzerland
  4. 4UNICEF USA, New York, New York, USA
  5. 5Catholic University of the Sacred Heart Rome, Rome, Italy
  6. 6Io Donna, Milan, Italy
  7. 7Corriere della Sera, Milan, Italy
  8. 8Ospedale San Carlo di Nancy, Rome, Italy
  9. 9Fondation Botnar, Basel, Switzerland
  10. 10Italian Chamber of Deputy, Rome, Italy
  11. 11Italian Senate of the Republic, Rome, Italy
  12. 12BD Global Health, Franklin Lakes, New Jersey, USA
  1. Correspondence to Dr Ana Pilar Betran; betrana{at}


The increase of caesarean sections (CS) represents a global concern. Interventions tested to reduce unnecessary caesareans have shown limited success to date, partly because they have focused on medical perspectives or on single faceted interventions targeting only one group of stakeholders. Limited attention has been given to examining multidisciplinary and advocacy activities that could reduce unnecessary CS by raising awareness and engaging the media, advocacy groups, healthcare professionals and politicians. In 2009 in Italy, the national CS rate was the highest in Europe and momentum was building for action.

This case study includes a description of the activities conducted in Italy during 2009–2012 by a partnership that included the non-governmental organisation Osservatorio Nazionale sulla Salute della Donna, a bipartisan group of Italian women parliamentarians and the WHO. The objectives were to generate awareness about the increase and overuse of CS in Italy, to foster political actions to reverse this trend, to engage with the media and journalists and to better understand women’s birth preferences and needs.

A reduction of the CS rate has been observed in Italy following the activities of the initiative from 38.4% in 2009 to 34.2% in 2015 according to the Ministry of Health. Although we cannot infer a casual association between the Partnership and the CS decrease, it did contribute to political momentum and specific actions that should, in theory, have contributed to this reduction. These include the engagement of women parliamentarians for policy change, improved understanding of the local drivers of increases of CS including women’s needs and preferences, raising awareness and working with the media to convey appropriate information and an inclusive strategy giving the opportunity to local stakeholders to make their voices heard.

This partnership initiative illustrates a model for generating dialogue, reflection and action in countries showing signs of readiness to address escalating CS.

  • health policy
  • health systems
  • maternal health
  • obstetrics
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Handling editor Seye Abimbola

  • Contributors All coauthors contributed to the conception and design of the initiative and its activities. PM, MM and APB conceptualised and prepared the first draft of the manuscript. All authors revised the manuscript critically and contributed to the final version. All authors approved the final version of the manuscript. APB is the guarantor of the study.

  • Funding This study was funded by UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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