The effects of a national policy to reduce c‐sections in Brazil

Abstract

In this paper, we assess the effects of a national policy implemented in Brazil to avoid unnecessary cesareans. The policy has a supply‐side component that prohibits elective c‐sections before the 39th gestational week and a demand‐side awareness component. Since the policy is not binding for cases with a strong medical c‐section indication, we use births of breech‐ and transverse‐positioned babies as a counterfactual for births of cephalic‐positioned babies in a difference‐in‐differences framework. Our results reveal that the policy decreases the rate of c‐sections by 1.6 percentage point, and slightly increases gestational time, birthweight, and first‐minute APGAR scores. There is evidence that policy effectiveness is driven by its demand‐side component.