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The effect of the two-child policy on cesarean section in China: Identification using difference-in-differences
Di Tang1, Audrey Laporte2, Xiangdong Gao3
1Shanghai University of Medicine and Health Sciences, 279 Zhouzhu Highway, Pudong New Area, Shanghai 201318, China; Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, No. 2669 Gaoke West Road, Pudong New Area, Shanghai 201204, China; School of Public Administration, East China Normal University, 3663 N. Zhongshan Rd, Shanghai 200062, China.
Midwifery
|February 8, 2022
Summary
China's universal two-child policy led to a significant decrease in cesarean section rates. This policy change may have altered maternal health risk perceptions, reducing the need for cesarean births.
Area of Science:
- Obstetrics and Gynecology
- Public Health Policy
- Reproductive Health
Background:
- China faces high cesarean section rates globally.
- The previous one-child policy may have contributed to these high rates.
- Policy shifts, like the relaxation of birth limits, could impact cesarean delivery trends.
Purpose of the Study:
- To evaluate the impact of China's universal two-child policy on cesarean section rates.
- Utilizing patient-level data from a major Shanghai hospital.
- Assessing the policy's influence on obstetric interventions.
Main Methods:
- Quantitative study design employing difference-in-differences (DID) estimation.
- Analysis of 133,358 inpatient delivery records from January 2013 to May 2018.
- Stratified DID analysis by maternal migrant status and age to control for confounding factors.
Main Results:
- A statistically significant reduction in cesarean section rates was observed, decreasing from 49.5% to 43.3%.
- The universal two-child policy was associated with this decline in cesarean deliveries.
- The effect was analyzed across different maternal subgroups.
Conclusions:
- The universal two-child policy is linked to a notable decrease in cesarean section rates.
- This reduction may stem from altered maternal perceptions of health risks associated with the policy change.
- Enhanced health education regarding the risks of repeat cesarean sections is recommended for pregnant women.
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