Geographic Variation in Cesarean Sections in the United States: Trends, Correlates, and Other Interesting Facts

Sarah Robinson, Heather Royer and David Silver

Journal of Labor Economics, 2024, vol. 42, issue S1, S219 - S259

Abstract: Analyzing data spanning three decades covering the near universe of births, we study county-level differences in 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 counties with high C-section rates 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.

Date: 2024
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