Background: High cesarean birth rates are an issue of international public health concern. The purpose of this paper was to examine the annual incidence and secular trend of cesarean births in Hong Kong and to correlate these rates with socioeconomic, demographic, and health indicators for the population since 1987.
Methods: This was a descriptive and ecologic study. Annual population rates of cesarean sections were estimated for 1987 from a population-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.
Results: From 1987 to 1999 the overall annual cesarean section rate rose steadily from 16.6 to 27.4 per 100 hospital deliveries, resulting in a 65 percent increase over 12 years. The mean difference in rates of surgical delivery 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 variations of cesarean delivery rates in Asia. The high rates and increasing trend represent an unnecessary excess risk for mothers and their infants. Various strategies combating high cesarean rates have been proposed and have succeeded elsewhere. Concerted action from health care professionals, public health authorities, the general population, and the media is urgently required to implement solutions to reduce the rate of cesarean delivery.