Womens autonomy in consent and debriefing for caesarean section: a thematic analysis of healthcare providers views and womens lived experiences and expectations in 20 hospitals across West Cameroon

Womens autonomy in providing informed consent for caesarean section (CS) and receiving post-operative debriefing is essential for a high-quality, women-centered experience of care. Yet, in many low-income settings, while the clinical quality of CS is known to be suboptimal, evidence on its woman-centredness remains limited. Our study examined womens autonomy around CS in 20 hospitals across nine health districts in the West Region of Cameroon. Between March 2024 and August 2024, we conducted in-depth interviews with 69 CS healthcare providers and 20 women within 30 days of a CS as well as 20 focus group discussions with 128 pregnant women attending antenatal clinics. Data were analyzed using inductive coding and thematic analysis of verbatim transcripts. Five themes reflected barriers to womens autonomous decision-making in consent for CS and post-operative debriefing interactions. These were: embeddedness in a patriarchal and collectivist society; primacy of the emergency situation in CS decisions; medical paternalism and womens deferential behavior; financial and logistical model of CS care; and weak regulatory framework for clinical practice. The sixth theme delineated a bold emancipatory counter-current, challenging the afore-mentionned barriers and promoting womens autonomy. Our results suggest that policymakers should promote consent guidelines that support womens agency and ensure debriefing focusses on their needs and social support. Community engagement should also address the deeply rooted influence of marital norms and womens limited financial resources in CS decision making.