Yan J, Wang L, Yang Y, et al. - Researchers examined how the universal two-child policy in China, which was announced in October 2015, have affected the cesarean birth rate. In addition, they examined the underlying influencing factors. National Free PrePregnancy Check-ups Project (NFPCP) formed the bases for this nationwide, retrospective, population-based study. Participants in NFPCP were couples who were planning to conceive in next 6 months. A standardized questionnaire with a face-to-face interview was used to obtain baseline information; in addition, medical examinations were conducted among the participants. Updated pregnancy status and outcomes were obtained in two rounds of follow-up interviews conducted by trained nurses. In the current study, researchers included NFPCP participants who completed deliveries before December 31, 2018. In the final analysis, a total of 9,398,045 participants were included. Observations revealed decreasing trend of cesarean birth rate after immediate release of the universal two-child policy. They indicated an increasing trend of cesarean birth rate 2–3 years after the policy. This study thereby emphasizes that the cesarean birth rate control is a long-lasting process and all the strategies need to be continually reinforced.