Summary of talk:
China has witnessed a rapid increase of cesarean section (CS) rates over the last three decades. It has been argued that non-clinical factors, including women’s personal preferences, are driving the increase in CSs. We conducted a mixed-methods systematic review and included longitudinal, cross-sectional, and qualitative studies in mainland China, Hong Kong, and Taiwan that investigated preferences for CS among women and family members and health professionals, and the reasons underlying such preferences. This review included 66 studies (47 quantitative and 19 qualitative studies). It shows a minority of women expressing a preference for CS, and that women’s preferences for CS are shaped by disincentivising healthcare system interactions, unsatisfactory relationships with providers, beliefs of deteriorating quality of care during labour and vaginal birth, and social support of the ‘right to choose’ CS. The rate of unnecessary CSs—those performed in the absence of medical indications—is unlikely to reduce without multifaceted strategies targeting health professionals and healthcare systems, in addition to women.
Prof. Long’s research interest and experience centres on health equity in relation to health systems development (with a focus on health financing and health services organization and delivery), including maternal and child health, tuberculosis control and non-communicable diseases management in poor areas and among vulnerable groups of China and other low- and middle-income countries. Prior to joining Duke Kunshan University, she worked in the Department of Reproductive Health and Research, World Health Organization, based in Geneva for over two years.