Declining Fertility and the Use of Cesarean Delivery: Evidence from a Population-Based Study in Taiwan

• Published in: Health services research Vol. 45; no. 5p1; pp. 1360 - 1375
• Main Authors: Ma, Ke-Zong M., Norton, Edward C., Lee, Shoou-Yih D.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-10-2010; Health Research and Educational Trust; Blackwell Publishing Ltd; Blackwell Science Inc
• Subjects: Adult; Birth Rate - trends; Births; Caesarean section; Causes of; cesarean delivery; Cesarean section; Cesarean Section - adverse effects; Cesarean Section - psychology; Cesarean Section - utilization; Choice Behavior; Community Health Planning; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - psychology; Elective Surgical Procedures - utilization; Female; Female infertility; Fertility; Health aspects; Health care policy; Health Care Surveys; Health Services Needs and Demand - trends; Health services utilization; Humans; Hypotheses; Infertility, Female; Longitudinal Studies; Maternal & child health; multinomial probit model; National health insurance; National Health Programs - statistics & numerical data; Patient Acceptance of Health Care - psychology; Patient Acceptance of Health Care - statistics & numerical data; Patient Selection; physician-induced demand; Preferences; Pregnancy; Pregnant Women - psychology; Regression Analysis; Research Briefs; Retrospective Studies; Social Values; Statistical models; Studies; Taiwan; Unnecessary Procedures - adverse effects; Unnecessary Procedures - psychology; Unnecessary Procedures - utilization; Women; Taiwan
• ISSN: 0017-9124; 1475-6773
• DOI: 10.1111/j.1475-6773.2010.01125.x

Objective. To test the hypothesis that declining fertility would affect the number of cesarean sections (c‐sections) on maternal demand, but not medically indicated c‐sections.
Data Sources. The 1996–2004 National Health Insurance Research Database in Taiwan for all singleton deliveries.
Study Design. Retrospective population‐based, longitudinal study. Estimation was performed using multinomial probit models.
Principal Findings. Results revealed that declining fertility had a significant positive effect on the probability of having a c‐section on maternal request but not medically indicated c‐section.
Conclusions. Our findings offer a precautionary note to countries experiencing a fertility decline. Policies to contain the rise of c‐sections should understand the role of women's preferences, especially regarding cesarean deliveries on maternal request.