Systematic review and modelling study of the global environmental impacts of caesarean sections mediated by infant feeding practices: protocol
6 affiliations
- 1College of Health Sciences, VinUniversity, Hanoi, Viet Nam
- 2Smart Green Transformation Center (GREEN-X), VinUniversity, Hanoi, Viet Nam
- 3Innovations in Health Sciences, VinUniversity, Hanoi, Viet Nam
- 4Health Research Institute, University of Canberra, Canberra, New South Wales, Australia
- 5College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
- 6Vinmec-VinUni Institute of Immunology, VinUniversity, Hanoi, Viet Nam
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.
Methods 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.
Ethics 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.
PROSPERO registration number: CRD420261399684.
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BibTeX
@article{nguyen2026systematic,
title = {{Systematic review and modelling study of the global environmental impacts of caesarean sections mediated by infant feeding practices: protocol}},
author = {Tuan Thanh Nguyen and Julie Smith and Doan Thi Thuy Duong and Mo Thi Tran and Susan Tawia and Chi Thi Du Tran},
journal = {BMJ Open},
year = {2026},
month = oct,
doi = {10.1136/bmjopen-2026-124493},
url = {https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-124493},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Systematic review and modelling study of the global environmental impacts of caesarean sections mediated by infant feeding practices: protocol
AU - Tuan Thanh Nguyen
AU - Julie Smith
AU - Doan Thi Thuy Duong
AU - Mo Thi Tran
AU - Susan Tawia
AU - Chi Thi Du Tran
PY - 2026
DA - 2026/10/27
JO - BMJ Open
DO - 10.1136/bmjopen-2026-124493
UR - https://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2026-124493
AB - 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. Methods 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. Ethics 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. PROSPERO registration number: CRD420261399684.
SN - 2044-6055
SN - 2044-6055
ER -