ASSESSMENT OF KNOWLEDGE AND
ATTITUDE REGARDING CAESARIAN
SECTION AMONG FEMALES IN
SULAYMANIYAH
Prepared by:
Awer Ahmad Aros Bestun
Shko Saeed Mirshad Sabir
Supervised by:
Dr. Abdulfattah Hawramey
Dr. Mohammed Jabary

Caesarian section is the delivery of a fetus through
surgical incision into the uterine wall after 28 weeks
gestation.
It is the most commonly performed obstetric operation
in the world.
The number of women requesting for delivery by
elective C-Section is increasing globally.

C-Section is performed when vaginal birth is deemed
hazardous either to the fetus or the mother.
The World Health Organization (2015) specified that 15%
is the rate of considered acceptable for delivery by C-
Section in each country since 1985.

The national CS rate of Great Britain and America have been
reported 23.8% and 32.8% respectively.
Nigeria (12.2% - 34.5%), Iran (26% - 66.5%), Turkey (45%).
In a 2018 survey, the CS rate of all births in Iraq was 33.2%,
The rate was higher in Kurdistan (45%) than the rest of Iraq
(30.9%).
The highest rates were in Erbil(49.1%) and Sulaymaniyah
(46.0%)

Like other types of major surgery, C-Section carries risks to
both babies and mothers.
Risks to babies include: Breathing problems and surgical
injury.
Risks to mothers include: Infection, blood loss, reactions to
anesthesia, blood clot formation, vaginal dryness,
dyspareunia(panful intercourse) after delivery, and the
progress takes longer than normal vaginal delivery.

The reason why we chose this topic is that C-Section
is a very common procedure in the world, and
especially in our country and in Sulaymaniyah it has a
high incidence rate.
Researches like this to assess knowledge and attitude
about C-Section among females haven’t been done
before in Sulaymaniyah.

Also a portion of women in our country think that
C-Section is safer and has less complications than
normal vaginal delivery when it is not.
The increased medical care needs of mothers and
babies following C-Section result in high economic
costs on the government and on the parents as well.

Primary aim of this study is to calculate the knowledge
and attitude about C-Section among female population
in the city of Sulaymaniyah.

To find out the knowledge about C-Section between the
different Socio-Demographic groups of the female
population:
Younger and Older age.
Married and Unmarried.
Those who live in Urban areas and those in Rural areas.
Educated and Uneducated females.

To find the Association of Attitude about C-Section among
the different Socio-Demographic groups:
Younger and Older age.
Married and Unmarried.
Those who live in Urban areas and those in Rural areas.
Educated and Uneducated females.

Design: Analytical Cross-Sectional study.
Research subjects: Female population in the city of
Sulaymaniyah, the acceptable age ranges from 17-62 years old.
Sampling method: Convenience & Online Form.
Setting: Conducted from Oct 31, 2022 until November 8, 2022.
Data processing and Analysis: Collected by Google forms &
Handout Questionnaires.
A Pilot Study had been done on 10 individuals

Permission was taken from the Family & Community
Medicine Department(University of Sulaymaniyah –
College of Medicine) after reviewing the questionnaire.
The participants were given freedom of choice in filling
out the forms.
They were informed about details of the survey.
They were assured of their data confidentiality and
anonymity.

Variables Frequency [n (%)]
Age (Years)
16-19 37(6.3%)
271(46.3%)
83(14.2%)
63(10.77%)
131(22.4%)
20-24
25-29
30-34
35 and above
Residency
Inside of city center 495(84.6%)
90(15.3%)
Outside of city center
Education
Primary 22(3.8%)
43(7.4%)
504(86.2%)
16(2.7%)
Secondary
Tertiary
None
Economic Status
High 29(5%)
541(92.5%)
15(2.6%)
Moderate
Low

Marital Status
Single 288(49.2%)
292(49.9%)
4(0.7%)
1(0.2%)
Married
Divorced
Widow
Parity
Nulliparous 317(54.2%)
99(16.9%)
169(28.9%)
Parity one
Multi-parous
Nationality
Kurd 579(99%)
4(0.7%)
2(0.3%)
Arab
Turkmen
Religion
Islam 564(96.4%)
2(0.3%)
19(3.2%)
Other
None

Knowledge statements
Results [n (%)]
Incorrect Correct
C-Section is less painful than vaginal delivery 250(42.7%) 335(57.3%)
C-Section requires blood transfusion in some cases 116(19.8%) 469(80.2%)
C-Section requires longer stay at hospital than natural birth 139(23.8%) 446(76.2%)
C-Section saves the life of the newborn 88(15%) 497(85%)
natural delivery is possible after C-Section 250(42.7%) 334(57.1%)
C-Section has more consequences than natural birth 161(27.5%) 423(72.3%)
There is less bleeding after C-Section than after vaginal delivery 422(72.1%) 162(27.7%)

Infection risks are higher in C-Section than natural delivery 221(37.8%) 363(62.1%)
Prolonged labor is an indicator for C-section 222(37.9%) 361(61.7%)
Bleeding per vaginal bleeding is an indicator for C-section 399(68.2%) 184(31.5%)
Small pelvis is an indicator for C-section 223(38.1%) 360(61.5%)
Malposition of baby is an indicator for C-section 202(34.5%) 381(65.1%)
Comp. of HTN is an indicator for C-section 374(63.9%) 209(35.7%)
Comp. of DM is an indicator for C-section 405(69.2%) 178(30.4%)
Mother's wish is an indicator for C-section 258(44.1%) 325(55.6%)
Total 585(100%)

405
69.2%
248
42.4%
140
23.9%
334
57.1%
63
10.8%
from friends & family
from the internet
from the TV
from doctors
other sources

257,
44%
113,
19%
215,
37%
Fair Good Poor

20
3.48%
429
74.61%
126
21.91%
Negative Neutral Positive

Attitude statement
Results [ n (%)]
Positive Neutral Negative
I prefer C-section over vaginal delivery as pain of natural delivery is
unpleasant
262(44.8%) 101(17.3%) 220(37.6%)
I believe C-Section is more preferable in absence of economic
problems
429(73.3%) 63(10.8%) 92(15.7%)
You (or your partner) are willing to undergo C-section if indicated? 482(82.4%) 76(13%) 22(3.8%)
I believe women that undergo C-section are considered weak in
personality
84(14.5%) 86(14.7%) 412(70.4%)
I believe C-section decreases affection between newborn and
mother
97(16.6%) 75(12.8%) 410(70.1%)

I believe babies born by C-section are healthier than those delivered
by vaginal delivery
106(18.1%) 141(24.1%) 335(57.3%)
I believe C-section is not God's wish 75(12.8%) 152(26%) 354(60.5%)
I believe C-section is a good choice for those contraindicated for
vaginal delivery
555(94.9%) 20(3.4%) 8(1.4%)
I believe that doctors/hospitals are deliberately recommending C-
section instead of vaginal delivery
251(42.9%) 144(24.6%) 188(32.1%)
I believe medical care during C-section is better than vaginal delivery 319(54.5%) 135(23.1%) 128(21.9%)
I believe C-section is more comfortable than vaginal delivery 327(55.9%) 92(15.7%) 163(27.9%)
Total 582(100%)

Socio-
Demographics
Knowledge Status
P-values
Residency
Fair Good Poor
[n (%)] [n (%)] [n (%)]
Inside of city center 224(87.16%) 87(76.99%) 184(85.58%)
0.039
Outside of city center 33(12.84%) 26(23.01%) 31(14.42%)
Age (years)
<25 136(52.92%) 73(64.6%) 123(57.21%)
0.111
>26 121(47.08%) 40(35.4%) 92(42.79%)

Marital status
Single 121(47.08%) 63(55.75%) 104(48.37%)
0.132
Married 135(52.53%) 47(41.59%) 110(51.16%)
Divorced 1(0.39%) 2(1.77%) 1(0.47%)
Widow 0(0%) 1(0.88%) 0(0%)
Education level
None 7(2.72%) 3(2.65%) 6(2.79%)
0.617
Primary 12(4.67%) 5(4.42%) 5(2.33%)
Secondary 18(7%) 5(4.42%) 20(9.3%)
Tertiary 220(85.6%) 100(88.5%) 184(85.58%)

Socio-Demographics Attitude Status
P-values
Age (years)
Negative
[n (%)]
Neutral
[n (%)]
Positive
[n (%)]
<25 12(60%) 277(64.57%) 37(29.37%)
<0.001
>26 8(40%) 152(35.43%) 89(70.63%)
Residency
Inside of city center 16(80%) 357(83.22%) 115(91.27%)
0.071
Outside of city center 4(20%) 72(16.78%) 11(8.73%)

Marital status
Single 11(55%) 243(56.64%) 29(23.02%)
<0.001
Married 9(45%) 183(42.66%) 95(75.4%)
Divorced 0(0%) 3(0.7%) 1(0.79%)
Widow 0(0%) 0(0%) 1(0.79%)
Education level
None 1(5%) 5(1.17%) 10(7.94%)
<0.001
Primary 3(15%) 6(1.4%) 13(10.32%)
Secondary 0(0%) 31(7.23%) 11(8.73%)
Tertiary 16(80%) 387(90.21%) 92(73.02%)

1. Interviewing people face to face for data collection.
2. Visitation of hospitals for data collection.
3. Very few researches have been done in this manner
in our city.

1. Having a limited time, decreasing the sample size and
rushing the data analysis.
2. Using convenient sampling method, thus having some
sample insufficiencies, for example having a low number
of participants from outside the city compared to those
from inside the city.

 Most of the participants in our study were
of young age, single, moderate economic
status, were at a tertiary educational level
and were from inside the city.

 We conclude that age and marital status did not
affect the knowledge scale among women, but
residency especially among rural participants had
better knowledge status.
 Generally, the majority of participants scored
fairly in the knowledge scale and most received
information from their family members and
friends.

 Generally majority of our participants had a
neutral attitude towards the operation.
 We conclude that residency did not affect the
attitude status among women towards C-section,
but age, marital status and educational level did
significantly diversify the attitude status.

 We recommend the ministry of health in
Sulaymaniyah to announce campaigns about C-section
to increase the knowledge of females about C-section
in the city.
 We also recommend our doctors to raise awareness
regarding the importance of C-Section and also the
risks and complications that follow the operation.

 We recommend our fellow students and doctors to
perform further researches regarding the topic as
there are insufficient data regarding this topic in
our city.
Decreasing the rate of unnecessary C-Section
operations should be a worldwide goal and to
tackle this problem more studies need to be
conducted.

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