title: Declining fertility and the use of cesarean delivery: evidence from a population-based study in Taiwan.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  The 1996-2004 National Health Insurance Research Database in Taiwan for all singleton deliveries.
  
  
  METHODS
  Retrospective population-based, longitudinal study. Estimation was performed using multinomial probit models.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Graduate Institute of Healthcare Administration, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan. kezong@kmu.edu.tw
authors.forename: Ke-Zong M
authors.initials: KZ
authors.lastname: Ma
authors.forename: Edward C
authors.initials: EC
authors.lastname: Norton
authors.forename: Shoou-Yih D
authors.initials: SY
authors.lastname: Lee
mesh_terms: D000328:Adult; D001723:Birth Rate / Q000639:trends*; D002585:Cesarean Section / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data*; D002755:Choice Behavior; D018672:Community Health Planning; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D005298:Fertility; D019538:Health Care Surveys; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D009313:National Health Programs / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D018579:Patient Selection; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology; D012044:Regression Analysis; D012189:Retrospective Studies; D012945:Social Values; D013624:Taiwan; D019564:Unnecessary Procedures / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data