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Delivery settings and cesarean section rates in China

Delivery settings and cesarean section rates in China
Delivery settings and cesarean section rates in China
OBJECTIVE: To quantify the influence of increasing use of health-care services on rising rates of caesarean section in China. METHODS: We used data from a population-based survey conducted by the United Nations Population Fund during September 2003 in 30 selected counties in three regions of China. The study sample (derived from birth history schedule) consisted of 3803 births to mothers aged less than 40 years between 1993 and 2002. Multiple logistic regression models were used to estimate the effect of health-care factors on the odds of a caesarean section, controlling for time and selected variables. FINDINGS: Institutional births increased from 53.5% in 1993-1994 to 82.2% in 2001-2002, while the corresponding increase in births by caesarean section was from 8.9% to 24.8%, respectively. Decomposition analysis showed that 69% of the increase in rates of caesarean section was driven by the increase in births within institutions. The adjusted odds of a caesarean section were 4.6 times (95% confidence interval, CI: 3.4-11.8) higher for recent births. The adjusted odds were also significantly higher for mothers who had at least one antenatal ultrasound test. Rates of caesarean section in secondary-level facilities markedly increased over the last decade to the same levels as in major hospitals (P < 0.001). CONCLUSION: The upsurge in rates of births by caesarean section in this population cannot be fully explained by increases in institutional births alone, but is likely to be driven by medical practice within secondary-level hospitals and women's demand for the procedure.
0042-9686
733-820
Sufang, Guo
3f41e705-6207-422b-afb6-892298ca0798
Padmadas, Sabu S.
64b6ab89-152b-48a3-838b-e9167964b508
Fengmin, Zhao
cf3252e4-c5b5-4ff3-8972-c2899d7c5bfe
Brown, James J.
daa64e89-38e6-424f-884e-225d3e4a986b
Stones, R. William
cc80809c-04a3-4dc0-8771-820de97c312d
Sufang, Guo
3f41e705-6207-422b-afb6-892298ca0798
Padmadas, Sabu S.
64b6ab89-152b-48a3-838b-e9167964b508
Fengmin, Zhao
cf3252e4-c5b5-4ff3-8972-c2899d7c5bfe
Brown, James J.
daa64e89-38e6-424f-884e-225d3e4a986b
Stones, R. William
cc80809c-04a3-4dc0-8771-820de97c312d

Sufang, Guo, Padmadas, Sabu S., Fengmin, Zhao, Brown, James J. and Stones, R. William (2007) Delivery settings and cesarean section rates in China. Bulletin of the World Health Organization, 85 (10), 733-820.

Record type: Article

Abstract

OBJECTIVE: To quantify the influence of increasing use of health-care services on rising rates of caesarean section in China. METHODS: We used data from a population-based survey conducted by the United Nations Population Fund during September 2003 in 30 selected counties in three regions of China. The study sample (derived from birth history schedule) consisted of 3803 births to mothers aged less than 40 years between 1993 and 2002. Multiple logistic regression models were used to estimate the effect of health-care factors on the odds of a caesarean section, controlling for time and selected variables. FINDINGS: Institutional births increased from 53.5% in 1993-1994 to 82.2% in 2001-2002, while the corresponding increase in births by caesarean section was from 8.9% to 24.8%, respectively. Decomposition analysis showed that 69% of the increase in rates of caesarean section was driven by the increase in births within institutions. The adjusted odds of a caesarean section were 4.6 times (95% confidence interval, CI: 3.4-11.8) higher for recent births. The adjusted odds were also significantly higher for mothers who had at least one antenatal ultrasound test. Rates of caesarean section in secondary-level facilities markedly increased over the last decade to the same levels as in major hospitals (P < 0.001). CONCLUSION: The upsurge in rates of births by caesarean section in this population cannot be fully explained by increases in institutional births alone, but is likely to be driven by medical practice within secondary-level hospitals and women's demand for the procedure.

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More information

Published date: October 2007

Identifiers

Local EPrints ID: 66626
URI: http://eprints.soton.ac.uk/id/eprint/66626
ISSN: 0042-9686
PURE UUID: 2ecdf290-9246-4a97-9e70-92b6f32cc5b5
ORCID for Sabu S. Padmadas: ORCID iD orcid.org/0000-0002-6538-9374

Catalogue record

Date deposited: 03 Jul 2009
Last modified: 11 Dec 2021 03:53

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Contributors

Author: Guo Sufang
Author: Zhao Fengmin
Author: James J. Brown
Author: R. William Stones

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