Factors influencing rising caesarean section rates in China between 1988 and 2008
OBJECTIVE: To identify factors driving the rapid increase in caesarean section in China between 1988 and 2008. METHODS: Data from four national cross-sectional surveys (1993, 1998, 2003 and 2008) and modified Poisson regression were used to determine whether changes in household income, access to he...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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The World Health Organization
2012-01-01
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| Series: | Bulletin of the World Health Organization |
| Online Access: | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862012000100010&lng=en&tlng=en |
| _version_ | 1797281518441201664 |
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| author | Xing Lin Feng Ling Xu Yan Guo Carine Ronsmans |
| author_facet | Xing Lin Feng Ling Xu Yan Guo Carine Ronsmans |
| author_sort | Xing Lin Feng |
| collection | DOAJ |
| description | OBJECTIVE: To identify factors driving the rapid increase in caesarean section in China between 1988 and 2008. METHODS: Data from four national cross-sectional surveys (1993, 1998, 2003 and 2008) and modified Poisson regression were used to determine whether changes in household income, access to health insurance or women's education accounted for the rise in caesarean sections in urban and rural areas. FINDINGS: In 2008, 64.1% of urban women and 11.3% of women in the poorest rural region reported giving birth by caesarean section. A fast rise was occurring in all socioeconomic groups. Between 1993 and 2008, the risk of caesarean section had increased more than threefold in urban areas (relative risk, RR: 3.63; 95% confidence interval, CI: 2.61-5.04) and more than 15-fold in rural areas (RR: 15.46; 95% CI: 10.46-22.86). After adjustment for improvements in income, education and access to health insurance over the study period, the RR dropped minimally in urban areas (RR: 3.07; 95% CI: 2.32-4.07), which suggests that these factors do not explain the rise; in rural areas, the adjusted RR dropped to 7.18 (95% CI: 4.82-10.69), which shows that socioeconomic change is only partly responsible for the rise. Socioeconomic region of residence was a more important driver of the caesarean section rate than individual socioeconomic status. CONCLUSION: The large variation in caesarean section rate by socioeconomic region - independent of individual income, health insurance or education - suggests that structural factors related to service supply have influenced the increasing rate more than a woman's ability to pay. |
| first_indexed | 2024-03-07T16:58:40Z |
| format | Article |
| id | doaj.art-103dddc5bdb342b5b9a998772869c8ab |
| institution | Directory Open Access Journal |
| issn | 0042-9686 |
| language | English |
| last_indexed | 2024-03-07T16:58:40Z |
| publishDate | 2012-01-01 |
| publisher | The World Health Organization |
| record_format | Article |
| series | Bulletin of the World Health Organization |
| spelling | doaj.art-103dddc5bdb342b5b9a998772869c8ab2024-03-03T03:29:02ZengThe World Health OrganizationBulletin of the World Health Organization0042-96862012-01-019013039AS0042-96862012000100010Factors influencing rising caesarean section rates in China between 1988 and 2008Xing Lin Feng0Ling Xu1Yan Guo2Carine Ronsmans3Peking University School of Public HealthMinistry of HealthPeking University School of Public HealthLondon School of Hygiene and Tropical MedicineOBJECTIVE: To identify factors driving the rapid increase in caesarean section in China between 1988 and 2008. METHODS: Data from four national cross-sectional surveys (1993, 1998, 2003 and 2008) and modified Poisson regression were used to determine whether changes in household income, access to health insurance or women's education accounted for the rise in caesarean sections in urban and rural areas. FINDINGS: In 2008, 64.1% of urban women and 11.3% of women in the poorest rural region reported giving birth by caesarean section. A fast rise was occurring in all socioeconomic groups. Between 1993 and 2008, the risk of caesarean section had increased more than threefold in urban areas (relative risk, RR: 3.63; 95% confidence interval, CI: 2.61-5.04) and more than 15-fold in rural areas (RR: 15.46; 95% CI: 10.46-22.86). After adjustment for improvements in income, education and access to health insurance over the study period, the RR dropped minimally in urban areas (RR: 3.07; 95% CI: 2.32-4.07), which suggests that these factors do not explain the rise; in rural areas, the adjusted RR dropped to 7.18 (95% CI: 4.82-10.69), which shows that socioeconomic change is only partly responsible for the rise. Socioeconomic region of residence was a more important driver of the caesarean section rate than individual socioeconomic status. CONCLUSION: The large variation in caesarean section rate by socioeconomic region - independent of individual income, health insurance or education - suggests that structural factors related to service supply have influenced the increasing rate more than a woman's ability to pay.http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862012000100010&lng=en&tlng=en |
| spellingShingle | Xing Lin Feng Ling Xu Yan Guo Carine Ronsmans Factors influencing rising caesarean section rates in China between 1988 and 2008 Bulletin of the World Health Organization |
| title | Factors influencing rising caesarean section rates in China between 1988 and 2008 |
| title_full | Factors influencing rising caesarean section rates in China between 1988 and 2008 |
| title_fullStr | Factors influencing rising caesarean section rates in China between 1988 and 2008 |
| title_full_unstemmed | Factors influencing rising caesarean section rates in China between 1988 and 2008 |
| title_short | Factors influencing rising caesarean section rates in China between 1988 and 2008 |
| title_sort | factors influencing rising caesarean section rates in china between 1988 and 2008 |
| url | http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862012000100010&lng=en&tlng=en |
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