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Declining fertility and use of Cesarian delivery: Evidence from a population-based study in Taiwan

Publication Abstract

Ma, Ke-Zong M., Edward Norton, and Shoou-Yih D. Lee. 2010. "Declining fertility and use of Cesarian delivery: Evidence from a population-based study in Taiwan." Health Services Research, 45(5): 1360-1375.


To test the hypothesis that declining fertility would affect the number of cesarean sections (c-sections) on maternal demand, but not medically indicated c-sections.

Data Sources

The 1996-2004 National Health Insurance Research Database in Taiwan for all singleton deliveries.

Study Design

Retrospective population-based, longitudinal study. Estimation was performed using multinomial probit models.

Principal Findings

Results revealed that declining fertility had a significant positive effect on the probability of having a c-section on maternal request but not medically indicated c-section.


Our findings offer a precautionary note to countries experiencing a fertility decline. Policies to contain the rise of c-sections should understand the role of women's preferences, especially regarding cesarean deliveries on maternal request.

DOI:10.1111/j.1475-6773.2010.01125.x (Full Text)

Country of focus: Taiwan.

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