OBJECTIVE: To examine the trend in the rate of cesarean delivery in primiparous women and to analyse individual socioeconomic factors driving the escalation of cesarean delivery rates in urban China. STUDY DESIGN: Data were drawn from three national household health surveys conducted in 1993, 1998, and 2003. This analysis was based on data from the primiparous women only. RESULTS: The cesarean delivery rate in urban cities of China rose from 18.2% in 1990 to 1992 to 39.5% in 1998 to 2002. The adjusted odds ratio for cesarean delivery associated with living in a large city, having university/colleague education, and having health insurance were respectively 2.39, 4.46, and 1.25 in 1998 to 2002. CONCLUSION: The cesarean delivery rate in urban cities of China has been rising dramatically since 1990. Many nonmedical causes related to individual social and economic factors might have played an important role in such a rapid rise of cesarean delivery rates.