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Background: China has witnessed a rapid increase of caesarean section (CS) rates in recent years. Several non-clinical factors have been cited as contributing to this trend including maternal request and perceived convenience. We aimed to assess preferences for mode of delivery and factors for preferences for CS in China to inform the development of future interventions to mitigate unnecessary CSs. Methods and Findings: We conducted a mixed-methods systematic review and included longitudinal, cross-sectional studies and qualitative studies in mainland China, Hong Kong and Taiwan that investigated preferences for mode of delivery among women and family members and health professionals, and the reasons underlying such preferences. We searched MEDLINE/PUBMED, EMBASE, CINAHL, Popline, PsycINFO, Global Health Library and one Chinese database (CNKI) using a combination of the following key terms “caesarean section”, “preference”, “choice”, “knowledge”, “attitude”, “culture”, “non-clinical factors”, “health professionals-patient relations” between 1990 and 2018 without language restriction. Meta-analysis of quantitative studies and meta-synthesis of qualitative studies were applied. We included 66 studies in this analysis: 47 quantitative and 19 qualitative. For the index pregnancy, the pooled proportions of preference for CS reported by women in longitudinal studies were 14% in early or middle pregnancy (95%CI 12-17%) and 21% in late pregnancy (95%CI 15-26%). In cross-sectional studies, the proportions were 17% in early or middle pregnancy (95%CI 14-20%), 22% in late pregnancy (95%CI 18-25%) and 30% at postpartum (95%CI 19-40%). Women’s preferences for CS were found to rise as pregnancy progressed (a mean difference to test preference change across longitudinal studies; mean difference 7%, 95%CI 1%-13%). One longitudinal study reported that the preference for CS among women’s partners increased from 8% in late pregnancy to 17% in the immediate postpartum. In addition, 18