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Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital
Yan-Jie Ji1, Hai-Bo Wang2, Zhi Bai1
1The First Dongguan Affiliated Hospital of Guangdong Medical University, Dongguan, China.
Frontiers in Medicine
|December 9, 2021
Summary
Achieving the World Health Organization's recommended Cesarean section (CS) rate of 10-15% is possible. Rigorous implementation of national policies at the hospital level can significantly reduce CS rates without increasing major complications.
Area of Science:
- Obstetrics and Gynecology
- Public Health Policy
- Health Services Research
Background:
- Rising global Cesarean section (CS) rates pose a significant public health challenge.
- The World Health Organization (WHO) recommends a CS rate not exceeding 10-15%.
- The feasibility of achieving this WHO recommendation remains uncertain.
Purpose of the Study:
- To evaluate the impact of national policies on Cesarean section rates in China.
- To compare Cesarean section trends in hospitals with rigorous versus non-rigorous policy implementation.
- To determine if the WHO-recommended CS rate is achievable without compromising patient safety.
Main Methods:
- A retrospective analysis of delivery data from 2008-2017 in two Chinese hospitals.
- Comparison of standardized annual CS rates between Longhua Hospital (rigorous policy implementation) and Dongguan Hospital (less rigorous implementation).
- Analysis of trends in relation to national and local policy changes, including the one-child policy relaxation.
Main Results:
- Longhua Hospital achieved a sharp decline in standardized CS rates from ~35% to 13.1% after 2010.
- Dongguan Hospital showed fluctuating CS rates, eventually rising to 35% by 2017.
- CS rates decreased across all risk classes in Longhua, but only in Robson class 2 in Dongguan; major complications did not differ.
- The proportion of women with a history of CS increased significantly in both hospitals.
Conclusions:
- Vigorous implementation of national policies at the micro-level is crucial for reducing Cesarean section rates.
- The WHO-recommended Cesarean section rate is achievable without an increase in major complications.
- Hospital-level policy adherence significantly influences the success of national public health initiatives.
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