The Effect of Increasing Women's Autonomy on Primary and Repeated Caesarean Sections in Brazil

Caesarean section (C-section) rates continue to rise globally. Yet, there is little consensus about the key determinants of rising C-section rates and the sources of variation in C-section rates across the world. While C-sections can save lives when medically justified, unnecessary surgical procedures can be harmful for women and babies. We show that a state-wide law passed in Sao Paulo (Brazil), which increased women's autonomy to choose to deliver via C-sections even when not medically necessary, is associated with a 3% increase in overall C-section rates. This association was driven by a 5% increase in primary C-sections, rather than repeated C-sections. These findings are notable given the already high C-section rate in Brazil (>55%) and given the likelihood of primary C-section leading to future births being delivered via C-section.