What does the relationship between Caesarian sections, women’s empowerment, and luxury goods from the US tell us about China?

This month the Lancet published a study which indicates that China’s rate of Caesarean birth is nearly 50%.  A commentary accompanying the article stated that if true, this was startling and chilling.  Other news sites also chipped in with details that supported this general sentiment.

From Shanghailist;

“…more than 60% of the hospitals in question were motivated by financial incentives to perform the costlier surgery. A C-section costs a patient 7,000 yuan, which is three and half times more expensive than a regular birth. And though it’s most likely a side effect of economic development that provides the option for more choice and comfort in childbirth, the prevalence of the practice has given people bizarre ideas about birthing:

From the Associated Press;

“In Asia, some women opt for the surgery to choose their delivery day after consulting fortune tellers for “lucky” birthdays or times. Others fear painful natural births or worry their vaginas may be stretched or damaged by a normal delivery. Some women also prefer the operation because they mistakenly believe it is less risky.

“I think it’s safer for the mother and child to have C-sections, and the relatives feel more secure because it’s very simple and very common now,” said a Vietnamese woman, Trang Thanh Van, 25, just days away from giving birth to her first child. “People worry that using tools to pull the baby out (in a vaginal birth) may affect their brains.””

From our very own China Healthcare Blog;

Chilling, indeed…for both America and China.  But, expect numbers to vary greatly across regions within China, even though researchers only looked at large hospitals. Also, a large number of Ceasarean births can be explained by repeat Caesarean births, which accounted for 13% of all American births in 2004.

This week, I used Nationmaster to see if the rate of C-sections correlated with any other country trends.  According to Nationmaster’s database, C-sections have a strong correlation with spending on luxury goods, including jewelery, and furs; with gold imports; and  with cotton imports. No other spending on imports correlates.

To me, this relationship indicates a link between increasing Caesarean rates and growing consumer culture.  Intuitively, this makes sense to me because Caesarean operations cost money and the society of consumer cultures puts a lot of pressure on people to spend money.  So two big things happen.  First, more people are able to ask for elective C-ections, like the mother’s who fear painful natural births.  Second, more doctors give in to performing C-sections when they might not be necessary because their cost of living, and their perceived consumer needs go up.

This starts to make more sense if you notice that there is also a negative correlation between C-section operations and gender empowerment, and between luxury goods spending and gender empowerment.  A negative correlation means that,

1) The lower the gender empowerment, the higher the rate of C-sections, and

2). The higher the luxury goods spending, the lower the gender (women’s) empowerement.

Why does this matter? The majority of doctors in countries with low gender empowerment are male.  The lower the gender empowerment in a country, the lower the overall education of women in that country.  This state of affairs creates opportunities for women to be goaded into having Caesarean sections more easily than elsewhere.  In essence, where gender empowerment is low, male doctors, holding a large amount of authority both because they are doctors and male, can more easily pressure women into a Caesarean section than, lets say, if those women were, on the average better educated about their choices (and therefore more assertive about how their birth should proceed) and had a female doctor in their corner who would more readily respect  wishes for a natural birth.

Combined that with the previously mentioned observation that a rising consumer culture might be responsible for creating an environment where doctors are negatively incentivized, and you have yourself a pretty good place to start when looking at why China’s Caesarean rates are nearing 50%.  Being both male dominated and in the midst of a transition from socialism to consumerism, China is a place where undereducated and/or underpowered women are likely to be goaded into a Caesarean section more easily than their counterparts in countries where women’s empowerment is greater, and consumerism is lower.  Turns out, it might all go back to the end of communism, and not the other way around.

Based on this data, I am willing to bet that other developing countries with similar make ups also have C-section rates substantially higher than what would be considered normal.  Unfortunately, data for C-sections in this category of country are hard to come by.

Thank you gertrudestein for sharing your photos on flickr