Cesarean Rate In China Not As High As Previously Thought

Research shows that cesarian delivery rate in China is lower than the World Health Organization’s estimate.

AsianScientist (Jan. 11, 2017) – Although still high, the cesarean rate in China is lower than the World Health Organization (WHO) estimate when rural areas are taken into account. These findings have been published in JAMA.

Overuse of cesarean surgeries can jeopardize the health of mothers and babies. As China is home for about one-fifth of the world’s population, Chinese health care practices have a big impact on global health. That’s why the public health community was alarmed when in 2010 the WHO reported that 46.2 percent of Chinese babies were delivered by cesarean.

The present study by Dr. Jan Blustein, Professor of Health Policy and Population Health at New York University, finds the current Chinese cesarean rate is substantially lower than the WHO figure: 34.9 percent in 2014, a figure comparable to the United States rate for the same year (32.2 percent).

In explaining the discrepancy between the WHO study and the new work, Blustein noted that the WHO study drew on a small number of hospitals located mostly in cities, while the new study drew on births throughout China. The new study was also the first to document large geographic variations in rates across different geographic areas of China. In some ‘supercities,’ rates were well in excess of 50 percent throughout the study period, while in some rural areas, rates were lower than 20 percent throughout.

The study was a collaboration between US and Chinese researchers. In addition to Blustein, the study was directed by: Professor Liu Jian-Meng and Assistant Professor Li Hong-Tian, both from Peking University.

“Variations in delivery practices are opportunities for improvement,” said Liu, the study’s senior co-author from China. “In areas where cesarean rates are very low, we can provide training and other resources to make sure that cesarean is available when needed. In cities where rates are high, efforts can be targeted to encourage vaginal delivery, when it is appropriate.”

Interestingly, large geographic variations in cesarean rates are also found in the United States. For example, in 2010 the rate was 22.6 percent in Alaska, but 38.8.4 percent in New Jersey.

“We don’t know exactly what drives these variations in delivery patterns in the US—it could have to do with doctor’s and hospital’s financial incentives, fears of malpractice claims, sheer convenience for obstetricians, or patient preferences. Our Chinese colleagues say that the same set of factors are at play in China,” said Blustein.

While the study generally showed a growth in cesarean in China over time, it found a decrease in cesarean use over time in some of China’s ‘super cities’ such as Beijing and Shanghai. For example, in Beijing the rate fell from 59.2 percent in 2008 to 43.2 percent in 2014, while in Shanghai fell from 68.0 percent to 52.4 percent during the same period. These drops may reflect national and local policy efforts to reduce the cesarean rate, by providing training, resources, and financial incentives.

The article can be found at: Li et al. (2017) Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014.


Source: New York University; Photo: il-young ko/Flickr/CC.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.

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