Why does China have the world's highest C-section rate?

What women really think about news, politics, and culture.
Jan. 3 2012 5:42 PM

Cesarean Nation

The cautionary tale of how China came to have the world's highest C-section rate.

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But whatever the exact mix of reasons for cesareans becoming normalized in the first place, their popularity is now self-perpetuating. In what may well be a cautionary tale for other countries whose rates are rising, many Chinese women now ask for cesareans, with the result that C-sections with no medical indication account for a quarter of cesareans in China, according to the WHO study (compared with 7 percent for all of Asia).

Ultimately, the one-child policy’s most significant contribution to China’s high C-section rate may lie in having erased any fear of the complications cesareans create for later deliveries. After all, the cesarean’s most significant risks to the mother—like a ruptured uterus or hemorrhaging caused by abnormalities in the placenta—only arise with later births. That may explain the attitude of women like Huang Na, a 31-year-old dentist in Shanghai who planned to have a natural birth but opted for a cesarean at the last minute in order to get the baby out before her husband left on a business trip. (She is not related to Huang Juejue.)

China may be approaching a turning point, however. Earlier this year a Beijing municipal health official condemned the popularity of C-sections and announced his department would launch a training program for midwives. Meanwhile, signs point to natural childbirth becoming trendy. Water births, while still rare, are now available in the most developed cities, as are an array of posh services directed at women wanting natural births; Antai Maternity Hospital, for example, offers birthing rooms with themes like “Mongolia” and “White House.” And some expectant women in the urban elite are beginning to seek out hospitals with lower cesarean rates, believing they’ll get better care.


If the C-section rate doesn’t start coming down soon, the Chinese government may find itself in a quandary. The one-child policy was only intended to last one generation, and calls for scaling it back are mounting. “The problem will be when they relax the one-child policy,” Beijing United Family Hospital’s Afnan said. “They’re going to have to be careful with all of these women who have had a C-section.”

Mara Hvistendahl is a correspondent with Science and the author of Unnatural Selection: Choosing Boys Over Girls, and the Consequence of a World Full of Men. Follow her on Twitter here.