Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital

Background: To address the worldwide dramatically increased Cesarean section (CS) rate in the past decades, WHO has recommended the CS rate should not be higher than 10–15%. Whether it is achievable remains unknown.Methods: We collected the data of delivery from 2008 to 2017 in two typical regional...

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Autores principales:	Yan-Jie Ji, Hai-Bo Wang, Zhi Bai, Da-Jian Long, Kaidong Ma, Jie Yan, Yun-Xiu Li, Yang-Feng Wu, Huixia Yang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	health policy policy implementation China cesarean section rate one-child policy Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/6a880bb032b44c30a280c129e8d8e151
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spelling	oai:doaj.org-article:6a880bb032b44c30a280c129e8d8e1512021-11-22T05:56:11ZAchieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital2296-858X10.3389/fmed.2021.774487https://doaj.org/article/6a880bb032b44c30a280c129e8d8e1512021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.774487/fullhttps://doaj.org/toc/2296-858XBackground: To address the worldwide dramatically increased Cesarean section (CS) rate in the past decades, WHO has recommended the CS rate should not be higher than 10–15%. Whether it is achievable remains unknown.Methods: We collected the data of delivery from 2008 to 2017 in two typical regional hospitals in China: Longhua Hospital (national policies rigorously implemented) and Dongguan Hospital (national policies not rigorously implemented). We compared between the two hospitals the 10 years trend in annual rate of CS, standardized by age, education level, parity, and CS history, against the time of issuing relevant national, local, and hospital policies.Results: In 10 years, 42,441 women in Longhua and 36,935 women in Dongguan have given birth. China's first national policy on CS reduction was issued in 2010 and the formal relaxation of one-child policy was issued in 2015–2016. In Longhua, the standardized annual CS rate was around 35% in 2008–2009, which declined sharply since 2010 down to 13.1% in 2016 (p < 0.001) and then leveled off. In contrast, in Dongguan, the rate stayed around 25% at the beginning, increased to 36% in 2011, decreased sharply to 27% in 2012, and leveled off until 2015 (p < 0.001), and then bounced back to 35% in 2017. The proportion of women with the history of CS increased significantly in the two hospitals (both roughly from 6% before 2010 to 20% after 2015). Analyses stratified by modified Robson classification showed that CS rates reduced in all risk classes of delivery women in Longhua but only in the Robson class 2 group in Dongguan. Major complications did not differ by hospital.Conclusion: With vigorously implementing national policies at micro levels, the WHO-recommended CS rate could be achieved without increase in major complications.Yan-Jie JiHai-Bo WangZhi BaiDa-Jian LongKaidong MaJie YanYun-Xiu LiYang-Feng WuHuixia YangFrontiers Media S.A.articlehealth policypolicy implementationChinacesarean section rateone-child policyMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	health policy policy implementation China cesarean section rate one-child policy Medicine (General) R5-920
spellingShingle	health policy policy implementation China cesarean section rate one-child policy Medicine (General) R5-920 Yan-Jie Ji Hai-Bo Wang Zhi Bai Da-Jian Long Kaidong Ma Jie Yan Yun-Xiu Li Yang-Feng Wu Huixia Yang Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital
description	Background: To address the worldwide dramatically increased Cesarean section (CS) rate in the past decades, WHO has recommended the CS rate should not be higher than 10–15%. Whether it is achievable remains unknown.Methods: We collected the data of delivery from 2008 to 2017 in two typical regional hospitals in China: Longhua Hospital (national policies rigorously implemented) and Dongguan Hospital (national policies not rigorously implemented). We compared between the two hospitals the 10 years trend in annual rate of CS, standardized by age, education level, parity, and CS history, against the time of issuing relevant national, local, and hospital policies.Results: In 10 years, 42,441 women in Longhua and 36,935 women in Dongguan have given birth. China's first national policy on CS reduction was issued in 2010 and the formal relaxation of one-child policy was issued in 2015–2016. In Longhua, the standardized annual CS rate was around 35% in 2008–2009, which declined sharply since 2010 down to 13.1% in 2016 (p < 0.001) and then leveled off. In contrast, in Dongguan, the rate stayed around 25% at the beginning, increased to 36% in 2011, decreased sharply to 27% in 2012, and leveled off until 2015 (p < 0.001), and then bounced back to 35% in 2017. The proportion of women with the history of CS increased significantly in the two hospitals (both roughly from 6% before 2010 to 20% after 2015). Analyses stratified by modified Robson classification showed that CS rates reduced in all risk classes of delivery women in Longhua but only in the Robson class 2 group in Dongguan. Major complications did not differ by hospital.Conclusion: With vigorously implementing national policies at micro levels, the WHO-recommended CS rate could be achieved without increase in major complications.
format	article
author	Yan-Jie Ji Hai-Bo Wang Zhi Bai Da-Jian Long Kaidong Ma Jie Yan Yun-Xiu Li Yang-Feng Wu Huixia Yang
author_facet	Yan-Jie Ji Hai-Bo Wang Zhi Bai Da-Jian Long Kaidong Ma Jie Yan Yun-Xiu Li Yang-Feng Wu Huixia Yang
author_sort	Yan-Jie Ji
title	Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital
title_short	Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital
title_full	Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital
title_fullStr	Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital
title_full_unstemmed	Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital
title_sort	achieving who's goal for reducing cesarean section rate in a chinese hospital
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/6a880bb032b44c30a280c129e8d8e151
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Achieving WHO's Goal for Reducing Cesarean Section Rate in a Chinese Hospital

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