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A mixed-method study of factors associated with differences in caesarean section rates at community level: The case of rural China

Huang, K, Tao, F, Faragher, Brian, Raven, Joanna, Tolhurst, Rachel, Tang, Shenglan and Van Den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2013) 'A mixed-method study of factors associated with differences in caesarean section rates at community level: The case of rural China'. Midwifery, Vol 29, Issue 8, pp. 911-920.

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Abstract

Objective
To assess population-based caesarean section (CS) rates in rural China and explore determinants and reasons for choosing a CS.
Design
Cross-sectional study, quantitative and qualitative methods, statistical modelling.
Setting
two rural counties in Anhui province, China.
Participants
(a) Household survey participants: 2326 women who gave birth in the two counties from January 2005 to December 2006; (b) Qualitative study participants: health providers at township and village level and maternal health-care providers (N=58).
Measurements and findings
The household survey were conducted among 2326 women, collecting data on socio-economic and health status and utilisation of maternal health services. Eleven Focus Group Discussions with health-care providers and users to explore perceptions surrounding CS.
The CS rate in the two areas were 46.0% and 64.7%. There were complex and different interactions among social-economic and clinical determinants associated with differences in CS rates. The main determinants that emerged were maternal age, maternal education, yearly income, primiparity, uptake of antenatal care and recorded obstetric complications with complex and differing interactions for each county. Maternal fear of pain, worry about mothers' and infants' safety, not satisfied with doctors' competences and physicians' low confidence in vaginal delivery, and absence of a strong midwifery cadre together contributed to final determination of CS.
Key conclusions
The CS rates were extremely high in the two counties in rural China. Maternal socio-economic, clinic characteristics and health providers' preference contributed together to the high rates of CS.
Implications for practice
Evidence-based knowledge and methods to reduce unnecessary CS should be communicated to medical professionals and women. Greater comprehensive attention needs to be paid to a complex pattern of medical, socio-cultural, political and economic contexts of maternity care.

Item Type: Article
Uncontrolled Keywords: Caesarean section; Determinant; Maternal behaviour; Physician's preference
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 85 Patients. Attitude and compliance
W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
WQ Obstetrics > Obstetric Surgical Procedures > WQ 430 Cesarean section. Symphysiotomy and similar techniques
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1016/j.midw.2012.11.003
Depositing User: q Moody
Date Deposited: 28 Jan 2014 10:16
Last Modified: 06 Feb 2018 13:06
URI: https://archive.lstmed.ac.uk/id/eprint/3522

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