Overall Rate of Cesarean Deliveries Increases in China

Between 2008 and 2014, the overall annual rate in China of cesarean deliveries increased from 29 percent to 35 percent, although rates were declining in some of the largest urban areas, according to a study appearing in the January 3 issue of JAMA.

Overuse of cesarean delivery can jeopardize maternal and child health. Since 2002, reducing the cesarean rate has been a national priority in China. Prior estimates of China’s cesarean rate have been based on surveys with limited geographic coverage. Jian-Meng Liu, M.D., Ph.D., of the Peking University Health Science Center, Beijing, China and colleagues examined the overall rate and change in rate of cesarean deliveries and geographic variation in cesarean use in China. The study, covering every county (n = 2,865) in mainland China’s 31 provinces, used county-level aggregated information on the number of live births, cesarean deliveries, maternal deaths, and perinatal deaths. The information was collected by the Office for National Maternal & Child Health Statistics of China from 2008 through 2014.

Over the study period, there were 100,873,051 live births, of which 32,947,229 (33 percent) were by cesarean delivery. In 2008, 29 percent of live births were by cesarean delivery; in 2014, that figure was 35 percent. Rates varied markedly by province, from 4 percent to 63 percent in 2014. Despite the overall increase, by 2014 rates of cesarean deliveries in 14 of the nation’s 17 “super cities” (population 5 million or more) had declined by 4.1 to 17.5 percentage points from their earlier peak values. In 4 super cities with the largest decreases, there was no increase in maternal or perinatal mortality.

The authors note that the 2014 cesarean rate of 35 percent is more comparable with that of the United States (32 percent in 2014) than rates reported for such middle-income countries as Brazil (56 percent).