Evidence map›Paper›PMID 35418438›Full record

ArticleBMJ open2022

Changes in caesarean section rates in China during the period of transition from the one-child to two-child policy era: cross-sectional National Household Health Services Surveys.

Qian Long, Yaoguang Zhang, Jing Zhang, Xiaojun Tang, Carol Kingdon

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In one paragraph

Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Qian LongGlobal Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China zhangyg@nhc.gov.cn qian.long@dukekunshan.edu.cn.ORCID 0000-0003-1444-6815
Yaoguang ZhangCentre for Health Statistics and Information, National Health Commission of the People's Republic of China, Beijing, China zhangyg@nhc.gov.cn qian.long@dukekunshan.edu.cn.
Jing ZhangNursing School, Hangzhou Normal University, Hangzhou, China.
Xiaojun TangSchool of Public Health and Management, Chongqing Medical University, Chongqing, China.ORCID 0000-0003-3486-1020
Carol KingdonSchool of Community Health and Midwifery, University of Central Lancashire, Preston, UK.ORCID 0000-0002-5958-9257

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesSince 2009, China has introduced policies, principally targeting health professionals, to reduce caesarean section (CS) overuse. In 2016, China endorsed a universal two-child policy. Advanced maternal age and previous CS may indicate changes in obstetric risks, which raise concerns on the need for and safety of CS. This study investigated changes in CS rates in 2008-2018, and factors associated with CS use during the period of transition from the one-child to two-child policy era.

designWe used births data from the cross-sectional National Household Health Services Surveys in 2013 and 2018.

settingPopulation-based national survey.

participantsWomen who had the last live birth within 5 years before the survey. PRIMARY OUTCOME MEASURE: CS rate.

resultsOverall CS use increased from 40.9% in 2008 to 47.2% in 2014 with significant increase in rural areas and the western region, and slightly decreased to 45.2% in 2018 with the greatest decrease among nulliparous women. Maternal request for CS by urban nulliparous women decreased from 36.8% in 2008-2009 to 22.2% in 2016-2018, but this change was not statistically significant in rural areas. Maternal age over 35 years old (OR 2.40, 95% CI 1.72 to 3.35) and births that occurred at a private hospital (OR 1.52, 95% CI 1.25 to 1.86) were associated with CS use among nulliparous women in 2016-2018. The CS rate among multiparous women increased over time. Individual socioeconomic factors associated with CS use among multiparous women.

conclusionsThe CS rate rise in China in 2008-2018 is attributable to increased use in rural areas and the less developed western region. The population policy shift, alongside facility policies for unnecessary CS reduction, are likely factors in CS reduction in urban areas. The challenge remains to reduce unnecessary CS, at the same time as providing safe, universal access to CS for women in need.

Indexed as

Cesarean SectionPolicyAdultChinaCross-Sectional StudiesFemaleHealth ServicesHumansPregnancyepidemiologyhealth policy

Identifiers

PMID35418438
PMCPMC9014066

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.