Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014

Abstract

veruse of cesarean delivery can jeopardize maternal and child health. 1,2 Concerns about "alarming" 3 rates in China increased after the World Health Organization (WHO) 4 reported that 46.2% of births were delivered by cesarean in the years 2007 and 2008, based on an analysis of 14 541 deliveries in 21 hospitals in 3 provinces. With a population of approximately 1.37 billion in 2014, China's health care use is of substantial global interest. Over the past 2 decades, the nation has invested in improving maternal and child health. The Law on Maternal and Infant Health Care was passed in 1995 to provide a high-quality hospital delivery to all women. 5 Health insurance expansion began in 2003, to provide better financial access to maternity care. 6 In 2009, a comprehensive health care reform plan included subsidies for in-hospital delivery to pregnant women in rural areas. 7 In 2008, 89.9% of deliveries occurred in hospitals, and 87.9% of families had health insurance. 6 By 2014, 99.6% of deliveries occurred in hospitals. 8 China's increasing cesarean rate has been spurred by many factors, including expanded access to hospital care, medicolegal concerns, financial incentives for physicians to perform cesareans, and parents' focus on having a "perfect baby" under the one-child policy. 9,10 Since 2002, reducing the cesarean rate has been a national priority, 11 and a variety of policies, programs, and activities have emerged at the central government, 12 provincial or municipal, 13 city, 14 and city district or county levels. 15 There is no national IMPORTANCE The increasing use of cesarean delivery is an emerging global health issue. Prior estimates of China's cesarean rate have been based on surveys with limited geographic coverage. OBJECTIVE To provide updated information about cesarean rates and geographic variation in cesarean use in China. DESIGN, SETTING, AND DATA SOURCES Descriptive study, covering every county (n = 2865) in mainland China's 31 provinces, using county-level aggregated information on the number of live births, cesarean deliveries, maternal deaths, and perinatal deaths, collected by the Office for National Maternal & Child Health Statistics of China, from 2008 through 2014. EXPOSURES Live births. MAIN OUTCOMES AND MEASURES Annual rate of cesarean deliveries. RESULTS Over the study period, there were 100 873 051 live births, of which 32 947 229 (32.7%) were by cesarean delivery. In 2008, there were 13 160 634 live births, of which 3 788 029 (28.8%) were by cesarean delivery and in 2014 there were 15 123 276 live births, of which 5 280 124 (34.9%) were by cesarean delivery. Rates varied markedly by province, from 4.0% to 62.5% in 2014. Despite the overall increase, by 2014 rates of cesarean delieries in 14 of the nation's 17 "super cities" had declined by 4.1 to 17.5 percentage points from their earlier peak values (median, 11.4; interquartile range, 6.3-15.4). In 4 super cities with the largest decreases, there was no increase in maternal or perinatal mortality. CONCLUSIONS AND RELEVANCE Between 2...

The Survey on Women’s Health in China

“…It also contributes to reduce the risk of cesarean delivery. The rate of cesarean delivery increased by years from 28.8% to 34.9% between 2008 and 2014 in China [6]. It was higher than the rate in this study.…”

“…For example, it was proved cesarean delivery was significantly associated with risk of autism spectrum disorder for each week of gestation, from week 36 to 42compared with vaginal delivery [7]. Study results also showed there was no increase in maternal or perinatal mortality in 4 super cities with the largest decreases of cesarean delivery rate [6].…”

Use of contraceptives and uptake of long-acting reversible contraception among postpartum women in rural China

“…Research evidence suggests that postpartum and intrapartum insertion of IUDs is feasible and does not interfere with normal uterine involution 23. Hence, to insert IUDs immediately after the placenta has been delivered should be strongly recommended as best practice in China, as the overall caesarean prevalence is 34.9%24 and 43.4% in the present study.…”

Cesarean section rates and local resources for perinatal care in Japan: A nationwide ecological study using the national database of health insurance claims

“…The recent increase in cesarean section (CS) rates (i.e. the number of cesarean deliveries performed per 100 live births) is a global health issue, especially in middle and high‐income countries . Although CS is an effective procedure to prevent maternal and perinatal morbidity and mortality, it may be accompanied by surgical complications (e.g.…”