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

Background: To address the worldwide dramatically increased caesarean section (CS) rate in the past decades, the World Health Organization (WHO) has recommended the CS rate should not be higher than 10-15%. Whether it is achievable remains unknown. Methods: We collected 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 two hospitals the 10 years trend in annual rate of CS, standardized by parity and CS history, against the time of issuing relevant national, local, and hospital policies. Findings: 42441 women in Longhua and 36935 women in Dongguan gave birth in the 10 years. China’s first national policy on CS reduction was issued in 2010 and the formal relaxation of one-child policy was in 2015-16. The standardized annual CS rate was around 40% in 2008-09, declined sharply since 2010 down to 10.9% in 2016 (p for trend <0.001) and leveled off then in Longhua. In contrast, the rate stayed around 30% at the beginning, started to decrease slightly since 2012 down to 26% in 2015 (p for trend <0.001), and then bounced back to 31% in 2017 in Dongguan. Proportion of women with history of CS increased significantly in 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. Interpretation: With vigorously implementing national policies at micro levels, the WHO recommended CS rate could be achieved without increase in major complications. Funding Information: The study was funded by Guangdong Provincial Science and Technology Plan (2017A020214007) and Dongguan Technology Development Society (201950715032188). Declaration of Interests: The author(s) declare that they have no competing interests. Ethics Approval Statement: The study was approved by the institutional review boards of the two participating hospitals. Informed consent was not obtained as this was a retrospective study and the data came from the hospital's medical records.