Restricting the timing of Elective CS: evidence from Brazil

Abstract

Brazil has one of the highest Cesarean Section (CS) rates in the world. It is a share of 58.3% reported by the Living Births Information System (SINASC) 2015-2017. It is well above the maximum rate of 15% recommended by the World Health Organization (WHO). In this paper, we estimate impacts and unintended consequences of the Resolution 2,144 from the Federal council of Medicine (CFM) on outcomes of Low Risk First Born births (LRFB). The Resolution introduces a minimum of 39th weeks of gestation for Elective CS. Elective CS before the 39th
week rate dropped 2.78 percentage points, which is statistically significant and equivalent to a 24% decrease in this outcome’s mean. We also find increases in birth’s time length: the percentage of births happening before the 39th week decreased 2.34 percentage points, which is a decrease of 6% in its average. Our results suggest that Elective CS’s were postponed from the 37-38th week to after the begin of the 39th week. We show that the policy had an unintended consequence once it seems to have changed the way potential spontaneous Natural Deliveries are anticipated from weekends to weekdays through Scheduled CS.