{
  "abstract": "Introduction: Climate change is intensifying extreme weather events, increasing the spread of infectious diseases and placing growing pressure on health systems. While fossil fuels remain a major focus, food systems and healthcare contribute substantially to greenhouse gas (GHG) emissions. Caesarean section (C-section) rates are rising globally, with many countries exceeding the WHO-recommended 10%–15%. Non-medically indicated C-sections are associated with higher environmental costs and reduced breastfeeding, leading to greater reliance on commercial milk formula (CMF), which has significant carbon and water footprints. This study aims to quantify the environmental impacts of C-sections mediated through infant feeding practices.\n\nMethods and analysis: This study will integrate systematic review, meta-analysis and data modelling approaches. First, a systematic review and meta-analysis will assess the impact of C-sections on breastfeeding and CMF use using predefined search strategies across major databases, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane methodologies. Second, global prediction models will estimate CMF-related carbon and water footprints using metadata from approximately 80–100 low- and middle-income countries. Third, national-level models will be developed and validated using Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Finally, environmental costs of C-sections will be estimated under different scenarios using model-derived parameters.\n\nEthics and dissemination: This study uses publicly available data and does not require ethical approval. Findings will inform policy, economic evaluations and strategies to reduce unnecessary C-sections and promote breastfeeding, contributing to climate mitigation efforts.\n\nPROSPERO registration number: CRD420261399684.",
  "abstract_shown": true,
  "affiliations": [
    "College of Health Sciences, VinUniversity, Hanoi, Viet Nam",
    "Smart Green Transformation Center (GREEN-X), VinUniversity, Hanoi, Viet Nam",
    "Innovations in Health Sciences, VinUniversity, Hanoi, Viet Nam",
    "Health Research Institute, University of Canberra, Canberra, New South Wales, Australia",
    "College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia",
    "Vinmec-VinUni Institute of Immunology, VinUniversity, Hanoi, Viet Nam"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0,
        1,
        2,
        3
      ],
      "name": "Tuan Thanh Nguyen",
      "orcid": "0000-0002-0737-430X"
    },
    {
      "affs": [
        0,
        1,
        3,
        4
      ],
      "name": "Julie Smith"
    },
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Doan Thi Thuy Duong"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Mo Thi Tran"
    },
    {
      "affs": [
        3
      ],
      "name": "Susan Tawia"
    },
    {
      "affs": [
        0,
        1,
        2,
        5
      ],
      "name": "Chi Thi Du Tran"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7c8r50pr716t7.bib",
  "cited_by": 0,
  "doi": "10.1136/bmjopen-2026-124493",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13723855/",
  "id": "7c8r50pr716t7",
  "issns": [
    "2044-6055",
    "2044-6055"
  ],
  "landing_url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-124493",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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    [
      "heading",
      "Global Health"
    ],
    [
      "heading",
      "Protocol"
    ],
    [
      "openalex",
      "2305|Environmental Impact and Sustainability"
    ]
  ],
  "openalex": "W7223859358",
  "pdf_url": null,
  "pmcid": "PMC13723855",
  "pmid": "42946351",
  "published": "2026-10-27",
  "publisher": "BMJ",
  "ris": "https://research.draconitic.com/paper/7c8r50pr716t7.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:44Z",
      "native_id": "10.1136/bmjopen-2026-124493",
      "source": "crossref",
      "url": "https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-124493"
    },
    {
      "first_seen": "2026-11-04T12:22:25Z",
      "native_id": "PMC13723855",
      "source": "pmc",
      "url": "https://doi.org/10.1136/bmjopen-2026-124493"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "heading:Global Health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Systematic review and modelling study of the global environmental impacts of caesarean sections mediated by infant feeding practices: protocol",
  "title_text": "Systematic review and modelling study of the global environmental impacts of caesarean sections mediated by infant feeding practices: protocol",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:20:36Z",
  "url": "https://research.draconitic.com/paper/7c8r50pr716t7",
  "venue": "BMJ Open",
  "versions": []
}