Rates of cesarean births in Hong Kong: 1987-1999

Background: High cesarean birth rates are an issue of international public health concern. The purpose of this paper was to examine the annual inciden ce and secular trend of cesarean births in Hong Kong and to correlate these rates with socioeconomic, demographic, and health indicators for the popul ation since 1987. Methods: This was a descriptive and ecologic study. Annua l population rates of cesarean sections were estimated for 1987 from a popu lation-based survey, and for 1993 through 1999 from government data sources . The number of excess cesarean sections was calculated for each year using the 15 percent upper limit as proposed by the World Health Organization. R esults: From 1987 to 1999 the overall annual cesarean section rate rose ste adily from 16.6 to 27.4 per 100 hospital deliveries, resulting in a 65 perc ent increase over 12 years. The mean difference in rates of surgical delive ry between public (mean(public) = 16.0%) and private (mean(private) 43.4%) institutions was 27.4 percent (95% confidence interval (CI) = 24.1, 30.7; p < 0.001). Conclusions: This is the first systematic report of secular vari ations of cesarean delivery rates in Asia. The high rates and increasing tr end represent an unnecessary excess risk for mothers and their infants. Var ious strategies combating high cesarean rates have been proposed and have s ucceeded elsewhere. Concerted action from health care professionals, public health authorities, the general population, and the media is urgently, req uired to implement solutions to reduce the rate of cesarean delivery.