Economic downturns and male cesarean deliveries: a time-series test of the economic stress hypothesis

Abstract

BackgroundIn light of the recent Great Recession, increasing attention has focused on the health consequences of economic downturns. The perinatal literature does not converge on whether ambient economic declines threaten the health of cohorts in gestation. We set out to test the economic stress hypothesis that the monthly count of cesarean deliveries (CD), which may gauge the level of fetal distress in a population, rises after the economy declines. We focus on male CD since the literature reports that male more than female fetuses appear sensitive to stressors in utero.MethodsWe tested our ecological hypothesis in California for 228 months from January 1989 to December 2007, the most recent data available to us at the time of our tests. We used as the independent variable the Bureau of Labor Statistics unadjusted total state employment series. Time-series methods controlled for patterns of male CD over time. We also adjusted for the monthly count of female CD, which controls for well-characterized factors (e.g., medical-legal environment, changing risk profile of births) that affect CD but are shared across infant sex.ResultsFindings support the economic stress hypothesis in that male CD increases above its expected value one month after employment declines (employment coefficient = -24.09, standard error = 11.88, p = .04). Additional exploratory analyses at the metropolitan level indicate that findings in Los Angeles and Orange Counties appear to drive the State-level relation.ConclusionsContracting economies may perturb the health of male more than female fetuses sufficiently enough to warrant more CD. Male relative to female CD may sensitively gauge the cohort health of gestations.

Economic Crisis Impact and Social Determinants of Perinatal Outcomes and Infant Mortality in Greece

“…Exploring the literature, two models of crisis impact on perinatal and infant health have been proposed [ 44 ]: A physiological model, which defines physiological pathways connecting economic conditions with health outcomes [ 21 , 22 , 23 , 24 , 25 ], and a healthcare model, which investigates the health outcomes in relation to the access to adequate and appropriate healthcare [ 26 , 27 , 28 , 44 ]. The design of the present study does not permit the investigation of possible physiological pathways connecting the economic crisis with health outcomes.…”

“…Studies exploring the mechanisms through which economic conditions affect children’s health suggest that malnutrition, infections, insufficient immunization, an increase of risky behaviors of parents, as well as changes in cohort composition may explain the effects on health outcomes [ 18 , 19 , 20 ]. Other studies suggest that economic stress has direct physiological effects, including a direct impact on the levels of several hormones and biomarkers, affecting fetuses and resulting in adverse outcomes [ 21 , 22 , 23 , 24 , 25 ]. On the other hand, harsh economic conditions are associated with reduced access to appropriate healthcare and with a deterioration of the maternal, neonatal, and infant care, which may be responsible for the deterioration of the corresponding health outcome [ 18 , 26 , 27 , 28 ].…”

Do Cesarean Delivery rates rise when the economy declines? A test of the economic stress hypothesis

“…This paper also examines whether stress caused by economic downturns affects the pregnant women severely enough to increase the probability of Cesarean Deliveries (CD) for male babies. My paper adds to the findings of Bruckner et al (2014) and the related literature in several ways.…”

“…Dehejia and Lleras-Muney, 2004;van den Berg et al, 2006van den Berg et al, , 2009van den Berg et al, , 2011. In addition, some recent findings suggest that stress caused by economic problems might have direct health effects on pregnant women and fetuses (Alessie et al, 2018;Olafsson, 2016;Bruckner et al, 2014). To test this economic stress hypothesis, Bruckner et al (2014) investigate the relationship between business cycles and the number of cesarean deliveries (CD) by a time series analysis using data on the monthly count of male CD in California from 1989 to 2007 and total state employment.…”

“…In addition, some recent findings suggest that stress caused by economic problems might have direct health effects on pregnant women and fetuses (Alessie et al, 2018;Olafsson, 2016;Bruckner et al, 2014). To test this economic stress hypothesis, Bruckner et al (2014) investigate the relationship between business cycles and the number of cesarean deliveries (CD) by a time series analysis using data on the monthly count of male CD in California from 1989 to 2007 and total state employment. They find that male CD increases above its expected value when employment declines, as male fetuses are more sensitive to adverse conditions in utero.…”