PURPOSE:
Does the kind of society a woman lives in matter for her choice of CS? This study investigates the practice of CS among populations with a matrilineal cultural heritage. I used a step-wise interdisciplinary research approach: 1) The conduct of a literature review of empirical research to identify matrilineal societies globally, including the now existing matrilineal societies and those of the past 2) Study of the prevalence of CS for the specific geographical areas 3) Search through sources in anthropology, history, art and archaeology to obtain knowledge about the social norms, traditions and value systems inherent in matrilineal society.

DISCUSSION:
Cesarean section delivery has substantially increased globally over the past few decades, reaching almost 30 million in 2020. This escalating trend has been observed in all regions and has emerged as a critical global health concern.

EVIDENCE WHERE RELEVANT:
Matrilineal societies were found in Asia, Africa, Europe, Oceania and the Americas. Some were found in indigenous contexts, others not. The prevalence of CS was consistently lower for any population with a matrilineal cultural heritage regardless of whether matrilineal tradition was practiced or fully practiced today. Where current epidemiological research was unable to explain differences in the prevalence of CS within similar populations, historical maps were cross-matched to the geography of present-day country boundaries showing the presence of past matrilineal culture: The status of women historically was different in the locations with lower CS prevalence today.

KEY MESSAGE:
The practice of CS is deeply rooted in culture and the status of women. The egalitarian status of women and men characteristic of matrilineal society and documented lesser violence against women are plausible explanations. Studies of CS have almost exclusively been conducted in societies of patriarchal origin. How women’s high status in existing and former matrilineal society seems to create resiliency to reproductive anxiety and CS practice needs attention. Labour and birth - miscellaneous