From one child policy to economic boom: factors affecting recent trends in child birth in China Tony Duan Dec. 6, 2015 Outline C-section rate and its changing trend in China C-section rates between resident and immigrant population C-section rates between medical practitioners and general population Change of one child policy and possible effects on C-section rate The C-section reduction initiative in China Basic Stats and Background Annual birth in China: 17 millions New Austrilia C Section rate 46.2% Lancet 2010; 375: Maternal mortality 23.2/100,000 Infant and perinatal mortality:9.5 Chinese Obgyn Physicians:190,000+ Basic Stats and Background Shanghai Population:25 Millions Annual birth:240,000 Life expectancy:82.47 yrs Maternal mortality:7.08/100,000 Perinatal mortality:3.78 Shanghai Obgyn Physicians: 5000 Basic Stats and Background Shanghai First Maternity and Infant Hospital(SFMIF) annual birth 25,000 Capacity 465 OB beds, Capacity of Annual birth 35,000-40,000 C-section rate in China C Section Rate in Asia C-Section Rate & GDP in Shanghai city & SFMIH C-section rates by different socio- demographic areas and provinces a The data of 1994 and 1995 was missing. b Five categories of areas in China were divided by the national health Ministry. The areas of the Urban and Rural Type I were the richest, and the rural type Iv was the poorest. The changing trends of C-section rates from 1988 to 2008 a by socio- economic areas b Data source: Feng X L, Xu L, Guo Y, et al. Factors influencing rising caesarean section rates in China between 1988 and 2008[J]. Bulletin of the World Health Organization, 2012, 90(1): A. a The family per capita income = family total income/ family members The changing trends of C-section rates from 1988 to 2008 by socio-demographic areas by household income a The changing trends of C-section rates in China The changing trends of C-section rates from 1988 to 2008 a by medical insurance a Mothers education The changing trends of C-section rates from 1988 to 2008 a by maternal education a The changing trends of C-section rates from 1988 to 2008 a by socio-demographic areas by parity a The changing trends of C-section rates in China C-section rate in China during 2015 The rates of different delivery modes in China (n=2507) a a 2507 cases were randomly selected from the national delivery survey in 2015 C-section rates between resident and migrant population The rates of delivery mode in resident and migrant population in China during 2015 (n=2507) a % % The rates of delivery mode in resident and migrant women in Shanghai First Maternity & Infant Hospital from 2012 to 2014 (n=41295) a A pregnant migrant women in Shanghai City, China C-section rates between resident and migrant population P < 0.05 % C-section rates between medical practitioners and general population However, the status seemed different in 2014. Change of one child policy and possible effects on C-section rate 1979 One-child per family policy 2001 Two-children policy if parents all from one-child families 2014 Two-children policy if one of the parents from one-child families a large proportion of women with previous CS a large proportion of women with previous CS Policy transition in China Robson 10 groups 16864/ (43.0%) Size of group % C/S rate in gp % Contr of each gp (43.0%) 1 Nullip single ceph >=37 wks spon lab 794/ Nullip single ceph >=37wks ind. or CS before lab 11217/ Multip (excl prev caesarean sections) single ceph >=37 wks spon lab 104/ Multip (excl prev caesarean sections) single ceph >=37wks ind. or CS before lab 2061/ Previous caesarean section single ceph >= 37 wks 660/ All nulliparous breeches 168/ All multiparous breeches (incl previous caesarean sections) 33/ All multiple pregnancies (incl previous caesarean sections) 1050/ All abnormal lies (incl previous caesarean sections) 39/ All single ceph