Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #104139

Sudha Xirasagar, PhD, Dept of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, SC 29208, (803) 576 6093, sxirasagar@sc.edu and Herng-Ching Lin, PhD, School of Health Care Administration, Taipei Medical University, 250 Wu_Hsing St., Taipei, 110, Taiwan.

ARIMA time series analysis is used to empirically examine the effects of cultural factors on maternal choice of cesarean delivery (CS) in Taiwan. Many Chinese believe the ‘ghost month' (lunar month of July) is inauspicious, causing major operations to end in grave complications. CS being an elective option for planned childbirth, we hypothesize that CS rates will be significantly lower during the lunar month of July (the shunned “ghost” month), and significantly higher than average rates in June (to preempt a July delivery). Population-based data from Taiwan's National Health Insurance Research Database (NHIRD) on all 1,262,222 singleton deliveries during 1997-2001 was used to test the hypothesis using ARIMA models. Monthly trends demonstrated a peak in CS rates in (lunar) June, followed by a trough in lunar July, with ARIMA-intervention models indicating that July was significantly associated with reduced CS rates, (p<0.001), and importantly, with significantly increased cesarean deliveries in June (p<0.0001). The study evidence supports our hypothesis of cultural factors impacting delivery mode within an ethnic Chinese community. The policy and research implications of our findings are critical. Given that Taiwan has population-based data on health care utilization and outcomes for several years, policy makers should sponsor longitudinal research studies to empirically document maternal and child health outcomes of July deliveries relative to other months to demonstrate to the public that the “ghost month” has no association with delivery complications. This should be followed by targeted health education in Taiwan to reduce unnecessary CS morbidity and costs.

Learning Objectives:

• Health care has become more widely accessible world-wide through group health insurance mechanisms. Together with increasing educational status of populations, it leads to increased utilization of health services with the associated escalation in costs, and sometimes, morbidity due to unnecessary care interventions. Cultural beliefs may contribute to unnecessary interventional childbirths, which need to be empirically investigated to understand the magnitude of impact and to demystify the public about these beliefs. This study offers an illustration of one such significant factor influencing CS rates and presents the implications for policy makers and researchers.

Keywords: Culture, International MCH

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.