Cesarean section delivery among primiparous women in rural China: an emerging epidemic

OBJECTIVE: The purpose of this study was to describe the trends and determinants of cesarean section (CS) delivery rates in rural China. STUDY DESIGN: Data on rural primiparous women aged 15-49 years (n = 10,754) were obtained from 3 nationwide representative surveys in 1993, 1998, and 2003. The CS rate per 100 births and odds ratios by women's background characteristics were calculated with the use of logistic regression. RESULTS: The CS rate increased from 1% in 1991 to 17% in 2002. After age adjustment, CS was most common among more educated women, who lived in Eastern China, who had high household income and health insurance, who used antenatal care, and who gave birth at a high-level hospital. CONCLUSION: This development over the 10-year period may indicate very high CS rates in the near future; the epidemic of the use of CS that has been observed in urban China is likely to occur also in rural China. Further studies on the reasons and consequences of such excessive use of operative delivery are needed.