Working Paper: NBER ID: w31871
Authors: Sarah Robinson; Heather Royer; David Silver
Abstract: Analyzing data spanning three decades covering the near universe of births, we study county-level differences in Cesarean section (C-section) rates among first-time mothers of singleton births. Our research reveals persistent geographic variation in C- section rates for both low- and high-risk groups. Counties with elevated C-section rates consistently perform more C-sections across mothers at all levels of appropriateness for the procedure. These elevated rates of C-section in high C-section counties are associated with reduced maternal and infant morbidity. We also find that C-section decisions are less responsive to underlying risks for Black mothers relative to white mothers, suggesting potential welfare-reducing disparities.
Keywords: C-section; healthcare variation; maternal health; infant health; geographic disparities
JEL Codes: I1
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Higher C-section rates in certain counties (R23) | Lower maternal and infant morbidity (J13) |
| 10 percentage point increase in high-risk C-section rates (J19) | 78 percentage point increase in low-risk C-section rates (Y10) |
| High measured C-section appropriateness for non-Hispanic black mothers (J15) | Fewer C-sections than similarly appropriate non-Hispanic white mothers (J79) |