Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Rodney Lemery


Cesarean section (CS) rates have generally increased across the world in the past decade. Reducing elective cesarean section (ECS) rates is imperative as many countries aim to maintain threshold CS rates at or below 15%, the level recommended by the United States' National Institutes of Health. Women are believed to consider ECS for various interconnected psychosocial reasons, but few quantitative studies have investigated these factors. This prospective cohort study was based on the social ecological model (SEM) and the theory of planned behavior (TPB) models, and identified the psychosocial predictors of ECS among 1,268 expectant women in 2 hospitals in Nairobi. Participants completed a structured questionnaire consisting of 10 validated psychosocial scales and were followed for actual mode of delivery (MoD) from hospital records and postnatal telephone interviews. The overall prevalence of CS and ECS were 16.0% and 6.4%, respectively; the CS rate was not statistically higher than the recommended 15% (p > 0.05). The combined CS incidence rate for these 2 hospitals was 83 per 1,000 births per month. Autonomy, fear of childbirth, pregnancy related anxiety, perceived social support from friends, and outcome expectancy for birth were statistically significant predictors of ECS, given the parity and age at first pregnancy, Ï?2(df = 19) = 77.735, p