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Women’s cesarean section preferences and influencing factors in relation to China’s two-child policy: a cross-sectional study

Authors Liang H, Fan Y, Zhang N, Chongsuvivatwong V, Wang Q, Gong J, Sriplung H

Received 18 April 2018

Accepted for publication 26 June 2018

Published 11 October 2018 Volume 2018:12 Pages 2093—2101

DOI https://doi.org/10.2147/PPA.S171533

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Ms Justinn Cochran

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen


Huijuan Liang,1,2 Yancun Fan,1 Nan Zhang,1 Virasakdi Chongsuvivatwong,2 Qingchun Wang,3 Jing Gong,3 Hutcha Sriplung2

1Research Institute for Health Policy of Inner Mongolia, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China; 2Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand; 3Department of Medical Education, Hohhot First Hospital, Hohhot, Inner Mongolia, China

Objective: This study explored women’s preference for cesarean section (CS) and the preference for cesarean sections’ influencing factors, particularly nonmedical factors.
Methods: A cross-sectional study was conducted in four tertiary hospitals in Hohhot. We recruited 1,169 pregnant women at ≥28 gestational weeks and classified subjects into three groups by delivery mode preference: vaginal birth (VB), CS, and “no clear preference”. We identified the influencing factors of women’s choices by multinomial logistic regression. The adjusted relative-risk ratios (aRRRs) for the factors affecting the preference for CS and “no clear preference” categories and their 95% CIs were computed, using the preference for VB as the reference group.
Results: VB was preferred by 80.3% of the subjects, 8.8% preferred CS, and 10.9% had not decided yet. In the multinomial logistic regression, pregnant women intending to have more than one child were less likely to prefer CS (aRRR: 0.37; 95% CI: 0.22–0.61); choosing a lucky day for baby birth was the strongest factor for CS preference (aRRR: 12.36; 95% CI: 6.62–23.08), and other factors for CS preference were being aged 40 years and above (aRRR: 4.21; 95% CI: 1.43–12.40), being ethnic minority (aRRR: 2.00; 95% CI: 1.17, 3.41), feeling difficulty in getting pregnant (aRRR: 2.23; 95% CI: 1.20, 4.13), and having husband’s preference for CS (aRRR: 7.62; 95% CI: 4.00–14.54). The top reasons for preferring CS were the belief that CS was safer (51.5%), associated with less pain (40.8%), and better for baby’s and woman’s health (24.3% and 22.3%, respectively).
Conclusion: Less than one-tenth of the study subjects preferred CS. The cultural beliefs had the strongest influence on the decision of delivery mode. Those intending to have two or more children following the two-child policy were less likely to choose CS.


Keywords: mode of delivery, vaginal birth, pregnant women, fertility intention

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