Changes in society drive rate higher

In the 1980s, cesarean sections accounted for about 15 percent of total births in China, but since then the rate has risen rapidly year-on-year, according to the National Health and Family Planning Commission.

The reasons behind the rise are varied, ranging from improvements in medical technology to a change in public attitudes towards C-section.

"In the 1960s and the 1970s, women were more frequently involved in manual work, such as farming. They did more exercise and their diets contained less fat and sugar, which resulted in favorable conditions for natural births," said Zhang Lihua, an retired obstetrician who worked at Beijing Obstetrics and Gynecology Hospital for many years.

The family planning policy adopted in the late 1970s has also contributed to the rising demand for C-section, according to Zhang, who said few women intend to have a second child, so they are less concerned about possible uterine damage as a result of a cesarean delivery.

"Families with older members, such as grandparents, place great importance on choosing an auspicious day or time for their babies to enter the world, and young couples often want to give birth before Sept 1, so the child can go to school a year earlier," she said.

Although she broadly agreed with Zhang, Ye Ronghua, an obstetrician at Peking University Third Hospital, said many factors are involved in the decision to undertake a C-section. The doctors may opt for one if the mother is insistent simply to avoid trouble, especially if a natural birth would involve an element of risk.

Wang Mishan, a professor at the obstetrics department at Peking University People's Hospital, said financial incentives have also led to the rise in the number of unnecessary cesareans in maternity hospitals. In some cities, the average cost of a C-section is double or triple that of a natural birth, which costs about 2,000 yuan ($322) in Beijing.

At Peking University Third Hospital, one of the capital's leading medical establishments, the C-section rate has stabilized at around 60 percent in recent years, according to a doctor who preferred not to be named.

C-sections have reached "epidemic proportions" in many countries, according to the UN health agency. In the United States, the rate is 31 percent of total births, while in Vietnam it's 36 percent, and 34 percent in Thailand. However, some countries, such as Japan, have maintained rates as low as 10 percent.

(China Daily 01/26/2015 page4)