Narrative Review on the Trend of Childbirth in South Korea and Feasible Intervention to Reduce Cesarean Section Rate

Abstract

In this study, we explored the current childbirth trend in South Korea to provide recent evidence on determinants of the cesarean section rate (CSR) and related policy interventions. We utilized national health insurance claim data to analyze the CSR. We also conducted a narrative review on factors associated with the CSR and examined evidence about interventions to reduce it. The CSR is rising in Korea; simultaneously, the overall number of births is declining. In 2012, 469,000 women gave birth, and 26.9% underwent a cesarean section. In 2021, 249,000 women gave birth, and 58.7% experienced a cesarean section. The CSR among women under age 25 was 26.7% in 2012, but by the first quarter of 2022, it was 51.6%. In 2012, the CSR in women aged 25–34 years was 34.9%; by the first quarter of 2022, it was 58.3%. We synthesized evidence on the determinants of CSR in three dimensions: users, providers, and systems. We also explored recent evidence on policy interventions to reduce the CSR, focusing on women and families, providers, and hospitals. Despite the rapid increase in the CSR in the last decade, efforts to investigate childbirth choice and women’s experiences have been insufficient. We could not locate systematic initiatives in the research community or government to lower the rate. More patient-centered efforts to reduce the high CSR rate are needed.