Background and Objective: Cesarean rate is increasing in most countries. This rate in Iran exceeds World Health Organization (WHO) recommendation. Thus, the aim of this study was to identify the determinants of cesarean section within a framework approach via defining the factors affecting it while determining its dimensions and inter-component associations. .

Materials and Methods: Using  meta-synthesis approach to analyze the results of previous studies, 711 articles were found  following  a thorough search in databases of SID, Magiran (in Iran), Scopus, Pub Med, and Google Scholar, some of which were eliminated due to being irrelevant, repetitive and inaccessibility of authors’ information. Finally, 96 articles were analyzed and factors affecting cesarean section were extracted and categorized based on themes and category.

Results: Medical, socio-cultural and economic factors affect the intention towards cesarean section. The most important medical factors in the tendency to cesarean section are previous cesarean, fetal distress, uncertainty about the fetal heart rate pattern, and dystocia. In the socio-cultural category, individual requests, mother education and fear of damage to the mother are the most important factors. In addition, physician recommendation and type of hospital are the most important factors in the economic category.

Conclusion: Based on this study, not only medical factors affect the intention towards cesarean section, but also socio-cultural and economic factors play dominant role. Other researches support these results by Shannon entropy. The results are deemed to be helpful for policy makers in formulation of policies to reduce the rate of cesarean section taking into account the most important factors influencing it. Also, researchers can achieve more comprehensive understanding of the issue by detailed study of the determinants, using meta-analysis and audit analysis.