The effect of increasing women's autonomy on primary and repeated caesarean sections in Brazil

de Oliveira Silva, Victor Hugo ORCID:, Lee, Ines and Quintana-Domeque, Climent (2022) The effect of increasing women's autonomy on primary and repeated caesarean sections in Brazil. Health Economics, 31 (8). pp. 1800-1804. ISSN 1057-9230

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Caesarean section (C‐section) rates continue to rise globally. Yet, there is little consensus about the key determinants of rising C‐section rates and the sources of variation in C‐section rates across the world. While C‐sections can save lives when medically justified, unnecessary surgical procedures can be harmful for women and babies. We show that a state‐wide law passed in São Paulo (Brazil), which increased women's autonomy to choose to deliver via C‐section even when not medically necessary, is associated with a 3% increase in overall C‐section rates. This association was driven by a 5% increase in primary C‐sections, rather than repeated C‐sections. Since the law emphasizes women's autonomy, these results are consistent with mothers' demand being an important contributor to high C‐section rates in this context.

Item Type: Article
Additional Information: ACKNOWLEDGEMENTS: The research described in this article relies on data administered by the Ministry of Health of Brazil. The Brazilian Registry of Live Births (Sistema de Informações sobre Nascidos Vivos, SINASC) is maintained by Datasus ( The authors did not receive any funding for this study.
Uncontrolled Keywords: caesarian sections,natural experiment,policy change,synthetic control,health policy,sdg 5 - gender equality ,/dk/atira/pure/subjectarea/asjc/2700/2719
Faculty \ School:
Faculty of Medicine and Health Sciences > Norwich Medical School
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 11 Jul 2022 09:30
Last Modified: 18 Aug 2023 15:30
DOI: 10.1002/hec.4522


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