Evaluation of Cesarean Rates for Term, Singleton, Live Vertex Deliveries in China in 2020 Among Women With No Prior Cesarean Delivery

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Abstract
Reducing the rate of cesarean delivery has been a public health focus in many nations, as cesarean overuse can be harmful to both mothers and their offspring1 and, in particular, can complicate future pregnancies.2 With the largest population and the second largest annual number of births worldwide,3 the cesarean delivery rate in China has drawn global concern since the World Health Organization reported a rate of up to 46.2% during 2007 to 2008.4 Between 2012 and 2016, the rate declined slightly, possibly due to a variety of initiatives taken by the Chinese government to curb cesarean use.5 Thereafter, the rate rebounded, which is likely attributable to the end of some initiatives and a growing proportion of older multiparous women with a prior cesarean delivery following implementation of the 2-child policy in China in 2016.6 Since 2018, the cesarean delivery rate has been surpassing 40% in urban areas of China and has even approached 35% in rural areas,6 far exceeding the benchmarks of 15% or 19%.7,8 In 2021, a 3-child policy was implemented in China,9 which may lead to further changes in maternal characteristics. Given the adverse health effects of cesarean delivery, control of its overuse must be reiterated.

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