Cesarean Nation

For Slate, Mara Hvistendahl looks at the cultural, economic and social factors behind the rise in the number of cesarean sections in China, which now has the highest rate of the procedure in the world:

…In the 1990s, as a nationalized health care system gave way to a market-based model, C-sections took off. According to a study published in the Bulletin of the World Health Organization in 2007, China’s cesarean rate quadrupled in just eight years, from an estimated 5 percent of all births in 1993-94 to 20 percent in 2001-02.

Behind the spike was a profound cultural shift. Huang Juejue, the mother of a 3-month-old daughter born via cesarean section, told me that her parents’ generation “grew up in the countryside and thought every woman could have a natural birth.” For modern expectant women, by contrast, the combination of the one-child policy and feverish economic development has yielded an environment in which they—and the in-laws and husbands who have so much riding on a single birth—fear any potential misstep. Not only are pregnant women in China expected to take supplements, eat bitter medicinal soups, and avoid strenuous physical activity, they are pressured to wear antiradiation vests to protect their bellies from cellular phone signals and thick, unbecoming overalls adorned with teddy bears believed to soothe Baby. Masoud Afnan, chair of the

Obstetrics and Gynecology Department at Beijing United Family Hospital, said that “with the one-child policy, people don’t want to take any risks.” And many in China mistakenly believe cesareans to be safer for both mother and child. “As much as I try to tell patients what the evidence shows,” Afnan continued, “it’s not really so easy to convince them.”

As disposable income grew, the C-section came to be seen as the logical endpoint of the micromanaged pregnancy. Today this 21st-century brand of control mixes with ancient numerology and fortune-telling. Ding Lidan, a 26-year-old Hangzhou resident who is eight months pregnant, told me, “If a woman here gets a cesarean, she will typically hire a fortune teller to predict a good date and time of day for the operation.” Those who can’t afford to hire out turn to free fortune-telling websites or rely on their own intuition. (The sixth and eighth days of the lunar month are popular. Conversely, no one wants to give birth on Tomb Sweeping Day.) In some cities, obstetrics ward administrators consult the lunar calendar in scheduling doctors’ shifts.


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