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Delivery settings and caesarean section rates in China
Guo Sufang1, Sabu S Padmadas, Zhao Fengmin
1United Nations Children's Fund, Beijing, China.
Bulletin of the World Health Organization
|November 27, 2007
Summary
Rising caesarean section rates in China are linked to increased healthcare use. Medical practices in hospitals and patient demand significantly drive this trend, not just more institutional births.
Area of Science:
- Public Health
- Maternal Health
- Healthcare Utilization
Background:
- Caesarean section rates have significantly increased globally.
- Understanding the drivers of this trend in China is crucial for maternal health policy.
Purpose of the Study:
- To quantify the impact of increased healthcare service utilization on rising caesarean section rates in China.
- To identify specific factors contributing to the caesarean section surge.
Main Methods:
- Utilized data from a 2003 United Nations Population Fund survey in 30 Chinese counties.
- Analyzed birth histories of 3803 mothers (1993-2002) using multiple logistic regression.
- Employed decomposition analysis to attribute changes in caesarean section rates.
Main Results:
- Institutional births rose from 53.5% to 82.2% (1993-2002).
- Caesarean section rates increased from 8.9% to 24.8% during the same period.
- 69% of the caesarean section increase was attributed to births within institutions; adjusted odds of caesarean section were 4.6 times higher for recent births.
Conclusions:
- Increased institutional births alone do not fully explain the caesarean section surge.
- Medical practices in secondary-level hospitals and patient demand are key drivers.
- Further investigation into clinical practices and patient preferences is warranted.
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