Changes in caesarean section rates in China during the period of transition from the one-child to two-child policy era: cross-sectional National Household Health Services Surveys

作者全名："Long, Qian; Zhang, Yaoguang; Zhang, Jing; Tang, Xiaojun; Kingdon, Carol"

作者地址："[Long, Qian] Duke Kunshan Univ, Global Hlth Res Ctr, Kunshan, Jiangsu, Peoples R China; [Zhang, Yaoguang] Natl Hlth Commiss Peoples Republ China, Ctr Hlth Stat & Informat, Beijing, Peoples R China; [Zhang, Jing] Hangzhou Normal Univ, Nursing Sch, Hangzhou, Peoples R China; [Tang, Xiaojun] Chongqing Med Univ, Sch Publ Hlth & Management, Chongqing, Peoples R China; [Kingdon, Carol] Univ Cent Lancashire, Sch Community Hlth & Midwifery, Preston, Lancs, England"

通信作者："Long, Q (通讯作者)，Duke Kunshan Univ, Global Hlth Res Ctr, Kunshan, Jiangsu, Peoples R China.; Zhang, YG (通讯作者)，Natl Hlth Commiss Peoples Republ China, Ctr Hlth Stat & Informat, Beijing, Peoples R China."

来源：BMJ OPEN

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000783232500051

JCR分区：Q1

影响因子：2.9

年份：2022

卷号：12

期号：4

开始页：　

结束页：　

文献类型：Article

关键词：health policy; epidemiology; epidemiology

摘要："Objectives Since 2009, China has introduced policies, principally targeting health professionals, to reduce caesarean section (CS) overuse. In 2016, China endorsed a universal two-child policy. Advanced maternal age and previous CS may indicate changes in obstetric risks, which raise concerns on the need for and safety of CS. This study investigated changes in CS rates in 2008-2018, and factors associated with CS use during the period of transition from the one-child to two-child policy era. Design We used births data from the cross-sectional National Household Health Services Surveys in 2013 and 2018. Setting Population-based national survey. Participants Women who had the last live birth within 5 years before the survey. Primary outcome measure CS rate. Results Overall CS use increased from 40.9% in 2008 to 47.2% in 2014 with significant increase in rural areas and the western region, and slightly decreased to 45.2% in 2018 with the greatest decrease among nulliparous women. Maternal request for CS by urban nulliparous women decreased from 36.8% in 2008-2009 to 22.2% in 2016-2018, but this change was not statistically significant in rural areas. Maternal age over 35 years old (OR 2.40, 95% CI 1.72 to 3.35) and births that occurred at a private hospital (OR 1.52, 95% CI 1.25 to 1.86) were associated with CS use among nulliparous women in 2016-2018. The CS rate among multiparous women increased over time. Individual socioeconomic factors associated with CS use among multiparous women. Conclusions The CS rate rise in China in 2008-2018 is attributable to increased use in rural areas and the less developed western region. The population policy shift, alongside facility policies for unnecessary CS reduction, are likely factors in CS reduction in urban areas. The challenge remains to reduce unnecessary CS, at the same time as providing safe, universal access to CS for women in need."

基金机构：Kunshan Municipal Government

基金资助正文：This work was supported by the Kunshan Municipal Government research funding.