A Dissertation Submitted in Partial Fulfillment of the Requirements for Award of the Master Degree in Health Systems Management of Mzumbe UniversityBackground: Different studies discovered rising of cesarean section (CS) rates in high and in middle to lower income countries (Litorp et al., 2013). One study shown CS rates among African countries ranged from 0.6% - 18% (Worjoloh, 2012). The study conducted by Pembe, 2010 revealed increased of CS rates in Tanzania. The other study found CS range in Tanzania was from 21.4% to 31.8% (Mpogoro et al. (2014). Objectives: The broad objective was to determine leading factors that lead to increase of CS; and specific objectives were to assess the trends of CS, to investigate the factors contributing to CS and to examine possible strategies to prevent unnecessary CS. Methodology: The study was exploratory case study using quantitative and qualitative methods. Simple random and purposive samplings were used and data were collected from 151 informants through interviews, questionnaire, FGD and checklist. Data were analyzed by SPSS version 20.0 and Microsoft Excel 2007. Findings: CS rates rose from 4.3% in 2011 to 5.7% in 2015. The first five leading indications for its rise were fetal distress (18.8%), obstructed labour (17.7%), previous cesarean delivery (12.9%), prolonged labour (9.3%) and malpresentation (8.1%). Reasons for its rise were inadequate health education to the community, inadequate knowledge and skills among health workers and inadequate medical equipment and supplies. The strategies/mechanisms identified were to provide health education to the community mothers inclusive, training and employing more health workers, and buying more medical equipment. Conclusions and policy implications: Although CS rates increased but some of them can be controlled. Policy makers should set policies which empower health workers to provide health education to the community, employ enough and trained health workers and put in place enough medical equipment and supplies.