Factors for rising caesarean rates, China.
Subject: Cesarean section (User statistics)
Health insurance industry (User statistics)
Pub Date: 05/01/2012
Publication: Name: Reproductive Health Matters Publisher: Elsevier Science Publishers Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2012 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2012 Source Volume: 20 Source Issue: 39
Topic: Event Code: 650 Sales & consumption
Product: SIC Code: 6321 Accident and health insurance
Geographic: Geographic Scope: China Geographic Name: China Geographic Code: 9CHIN China
Accession Number: 296571569
Full Text: Caesarean deliveries in China have increased rapidly, from 18% to 39% of urban primiparous women between 1990 and 2002. The rate in rural China has risen more slowly, but is now thought to be above 25%. 34,482 live births recorded in four national cross-sectional National Health Service surveys (1993, 1998, 2003 and 2008) were examined to assess the relative influence of changes in household income, access to health insurance and education between 1988 and 2008. Urban and rural areas were analysed separately.

Nationally, the caesarean section rate rose dramatically from 3.4% in 1988 to 39% in 2008. The biggest increase was among urban women, 64.1% of whom gave birth by caesarean section in 2008. Even in the least developed region the rate rose from nil in 1988 to 11.3% in 2008. Socio-economic region of residence was a more important determinant than individual socio-economic status. The rate was much higher in urban women with a low level of education than in similarly educated rural women. In 2008, caesarean rates were five times higher in the wealthiest region than in the poorest rural region, irrespective of individual household income, educational attainment or access to health insurance. Changes in single variables such as access to health insurance or increasing wealth do not explain the rising rate. Notably, health insurance payments may not be a key driver; the rate increased more rapidly among women without health insurance than among those with it in both urban and rural areas. The authors suggest two possible contributory factors. Due to China's one-child policy, parents who expect to have only one child may opt for what is perceived to be the safest delivery option. The increasing emphasis on deliveries attended by doctors and a related marginalisation of midwifery may also be a factor. More information is required on actual and perceived safety of caesarean section in China.

(1.) Feng XL, Xu L, Guo Y, et al. Factors influencing rising caesarean section rates in China between 1988 and 2008. Bulletin of World Health Organization 2012;90:30-39A.

Doi: 10.1016/S0968-8080(12)39627-4
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