CHINA IS TOO dependent on caesarian sections, a new commentary in the British Journal of Obstetrics and Gynaecology (BJOG) says.

In 2010, around 8 million children were delivered by c-section in China, the commentary says. That represents an exponential growth. Although the exact rate is not known, the current Chinese language literature on caesarean rates in China reports total caesarean rates ranging from 36% to 58%. However, before the 1980s, the caesarean rate was below 5% and it did not rise above 10% until after 1990.

The commentary, offering an analysis into reasons for the increase in caesarean section in the last few decades, concludes that China’s high caesarean section rate appears to be driven by three factors: the structure of the obstetric care system, provider incentives and cultural aspects of patient preference.

It pinpoints a number of reasons for thigh uptake of c-sections:

• The high number of deliveries, but low resources, favours c-sections
• Insurance coverage and other financial incentives promote its use
• Low staff levels in hospitals
• Varying levels of expertise in obstetrics
• Bonuses are paid to doctors who deliver by c-sections

Susan Hellerstein, Assistant Professor in Obstetrics and Gynaecology, Harvard Medical School, Brigham and Women’s Hospital, and co-author of the study said:

“Since the 1990’s China has seen a dramatic increase in caesarean delivery rates from less than 10% to over half of women now delivering via caesarean section. This is likely to change in the future and efforts must be made to encourage vaginal delivery by reforming certain aspects of the Chinese obstetric care system.”

“However, it is important to recognise that any efforts to decrease the caesarean section rate must take into account the safety and effectiveness of this delivery method in modern China and preserve maternal and perinatal health.”

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