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Cited by 11Maternal and Perinatal Health InterventionsDemographic Trends and Gender PreferencesReproductive Health and Contraception

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A Segmented Logistic Regression Approach to Evaluating Change in Caesarean Section Rate with Reform of Birth Planning Policy in Two Regions in China from 2012 to 2016

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Kang, Lili, Ye, Shangyuan, Jing, Kangzhen, Fan, Yancun, Chen, Qihui, Zhang, Ning, Zhang, Bo·2020·Risk Management and Healthcare Policy
DOI 10.2147/rmhp.s230923PMC PMC7092689
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Abstract

Objective: This study evaluated change in caesarean section rate with reform of birth planning policy in China from one-child to two-child policy. Methods: Study data were collected from patient-level hospital records of 59,668 pregnant women who visited three major urban hospitals in Jiangsu Province and Inner Mongolia Autonomous Region of China between January 2012 and December 2016. A segmented logistic regression approach was developed to evaluate the changes in caesarean section rate in these regions with the launch of China’s new partial and universal two-child policies in January 2014 and January 2016, respectively. Results: Jiangsu Province had a significantly lower non-emergency caesarean rate (Jiangsu 8.15% vs Inner Mongolia 34.03%, p < 0.001) and a much lower percentage of minority population (Jiangsu 6.99% vs Inner Mongolia 21.76%, p < 0.001) than Inner Mongolia Autonomous Region. In Jiangsu Province, no change in caesarean section rate was detected with the two-child policies (all p -values > 0.05), although the unadjusted trend change (0.038, 95% confidence interval or CI: [0.016, 0.060], p < 0.001) in log odds after the implementation of the partial two-child policy was statistically significant. In Inner Mongolia Autonomous Region, an immediate jump in caesarean section rate was discovered by the segmented logistic regression with the implementation of both the partial (unadjusted level change 0.297, CI: [0.105, 0.489], p = 0.002) and universal two-child policies (unadjusted level change 1.945, CI: [1.277, 2.614], p < 0.001); but the rate reverted to the previous level thereafter. Ethnicity, maternal age, maternal reproduction history, insurance coverage type, infant weight, and infant gender were the significant factors associated with caesarean section rate (for odds ratios, all p -values < 0.05). However, the significance of infant gender may stem from the large sample size of the study and is not clinically meaningful. Conclusion: Change in caesarean section rate was not observed with the launch of two-child policy in China. Keywords: one-child policy, two-child policy, caesarean section, segmented logistic regression

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Figure 1 Scatterplots of monthly caesarean section rates in Jiangsu and Inner Mongolia between 2012 and 2016 by month. Solid curves are segmented locally estimated scatterplot smoothing (LOESS) curves; dashed vertical lines denote the time points at which the partial and universal two-child policies were launched.
Figure 1 Scatterplots of monthly caesarean section rates in Jiangsu and Inner Mongolia between 2012 and 2016 by month. Solid curves are segmented locally estimated scatterplot smoothing (LOESS) curves; dashed vertical lines denote the time points at which the partial and universal two-child policies were launched.CC BY-NC · PubMed Central

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Metadata

Authors
Kang, L., Ye, S., Jing, K., Fan, Y., Chen, Q., Zhang, N., & Zhang, B.
Affiliations
  • Inner Mongolia Medical University (CN)
  • Harvard University (US)
  • Nanjing Drum Tower Hospital (CN)
  • China Agricultural University (CN)
  • University of Massachusetts Chan Medical School (US)
  • Boston Children's Hospital (US)
Corresponding author
Zhang, Bo
ORCID
Venue
Risk Management and Healthcare Policy
Publisher
Informa UK Limited
Published
2020-03
Volume
Volume 13
Pages
245-253
ISSN
1179-1594 (ISSN-L)
DOI
10.2147/rmhp.s230923
PMC
PMC7092689
OpenAlex
W3010939196
Cited by
11
References
28
Citations by year
2026: 1 · 2024: 1 · 2022: 2 · 2021: 2 · 2020: 5
FWCI
1.38
Type
journal article
Language
en
Open access
Licence
Locations
  • Risk Management and Healthcare Policy (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Social Sciences › Gender Studies › Demographic Trends and Gender Preferences
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
cesarean section rate, two-child policy, one-child policy, policy reform, Jiangsu Province, Inner Mongolia, ethnic minorities, maternal factors, infant weight, infant gender, insurance coverage, maternal age, China, regional comparison, policy evaluation

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CoChat. (2026). Citation check: A Segmented Logistic Regression Approach to Evaluating Change in Caesarean Section Rate with Reform of Birth Planning Policy in Two Regions in China from 2012 to 2016. https://app.cochat.ai/papers/10.2147/rmhp.s230923
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Kang, L., Ye, S., Jing, K., Fan, Y., Chen, Q., Zhang, N., & Zhang, B. (2020). A Segmented Logistic Regression Approach to Evaluating Change in Caesarean Section Rate with Reform of Birth Planning Policy in Two Regions in China from 2012 to 2016. Risk Management and Healthcare Policy. https://doi.org/10.2147/rmhp.s230923