In China, the increase in caesarean sections has been reported to
be a result of the national adoption and interpretation of WHO’s
safe motherhood policy and the Millennium Development Goals
(MDGs), resulting in the national policy for hospitalisation of all
births.155 In Brazil, the increases were despite a Ministry of Health
regulation in 2000 to reduce the increasing number of caesarean
sections;150 at least some contribution to this is driven by social
inequality and relates to women’s wish to have a caesarean
section to avoid substandard care in labour.156 Additionally, the
underlying trend is towards the increase of caesarean sections
without medical indications before labour. In China, caesarean
sections without medical indications in some hospitals have
grown from 5%157 in 1990 to 65·6% in 2010.158,159 China is
somewhat unique in that its one-child policy minimises the
likelihood of women having several caesarean sections and the
associated long-term placental problems. Similar to the situation
in China, Brazil’s data highlight a ten-fold increase in pre-labour
caesarean sections between 1990 and 2010.160