J Korean Med Sci.  2014 Oct;29(10):1341-1352. 10.3346/jkms.2014.29.10.1341.

Changes in the Cesarean Section Rate in Korea (1982-2012) and a Review of the Associated Factors

• Chung SH
• Seol HJ
• Choi YS
• Oh SY
• Kim A
• Bae CW

• KMID: 2129623
• DOI: http://doi.org/10.3346/jkms.2014.29.10.1341

Abstract

Although Cesarean section (CS) itself has contributed to the reduction in maternal and perinatal mortality, an undue rise in the CS rate (CSR) has been issued in Korea as well as globally. The CSR in Korea increased over the past two decades, but has remained at approximately 36% since 2006. Contributing factors associated with the CSR in Korea were an improvement in socio-economic status, a higher maternal age, a rise in multiple pregnancies, and maternal obesity. We found that countries with a no-fault compensation system maintained a lower CSR compared to that in countries with civil action, indicating the close relationship between the CSR and the medico-legal system within a country. The Korean government has implemented strategies including an incentive system relating to the CSR or encouraging vaginal birth after Cesarean to decrease CSR, but such strategies have proved ineffective. To optimize the CSR in Korea, efforts on lowering the maternal childbearing age or reducing maternal obesity are needed at individual level. And from a national view point, reforming health care system, which could encourage the experienced obstetricians to be trained properly and be relieved from legal pressure with deliveries is necessary.

Keyword

Cesarean Section Rate; Korea; Statistics; Trends

MeSH Terms

Cesarean Section/*statistics & numerical data/trends
Data Collection
Female
Humans
*Insurance, Health
Insurance, Liability
Maternal Age
Obesity/epidemiology
Pregnancy
Pregnancy, Multiple/statistics & numerical data
Republic of Korea
Social Class
Vaginal Birth after Cesarean/*statistics & numerical data/trends

Figure

• 

  Fig. 1 Mean age of the women at the birth of the first child in 2009 (12). (Modified using the OECD report by updating the Korean data). The mean age was higher in Korea (29.9 yr) compared to that in OECD countries (27.8 yr) in 2009.

• 

  Fig. 2 Maternal age at birth in the USA, England, and Korea in 2012 (10, 14, 15). The mean maternal age was higher in Korea (31.6 yr) compared to that in the USA (25.8 yr) and England (29.8 yr) in 2012.

• 

  Fig. 3 Comparison of the rate of OECD Cesarean section surgical procedures per 100 live births (OECD-CS SPR) in Korea with the mean OECD-CS SPR in OECD countries from 2001 to 2011 (11). The OECD-CS SPR in Korea was higher than the mean OECD-CS SPR in OECD countries.

• 

  Fig. 4 The Cesarean section rate in 2011 according to legal pressure (11, 16, 17). The following systems were considered: no-fault compensation system in Sweden, government sponsored no-fault compensation system and unitary compensation system in New Zealand, fault liability system in Japan, mistake lawsuit system in England, and civil litigation system in the USA, Australia, and Korea (Grouping by system: Group I, Sweden and New Zealand; Group IIa, Japan; Group IIb, England; Group III, USA, Australia, and Korea).

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