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Research ArticleArticles
Open Access

The Labor Market and Health Impacts of Reducing Cesarean Section Deliveries

Sarah Miller, Petra Persson, Maya Rossin-Slater and Laura R. Wherry
Published online before print September 09, 2026, 1025-14609R2; DOI: https://doi.org/10.3368/jhr.1025-14609R2
Sarah Miller
†University of Michigan Ross School of Business and NBER. Email:
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  • For correspondence: mille{at}umich.edu
Petra Persson
‡Stanford University, Research Institute of Industrial Economics, and NBER. Email:
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  • For correspondence: perssonp{at}stanford.edu
Maya Rossin-Slater
§Stanford University School of Medicine, NBER, IZA. Email:
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  • For correspondence: mrossin{at}stanford.edu
Laura R. Wherry
¶New York University Robert F. Wagner Graduate School of Public Service and NBER. Email:
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  • For correspondence: laura.wherry{at}nyu.edu
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References

  1. Agency for Healthcare Research and Quality, “A statewide collaborative to support vaginal birth and reduce unnecessary cesarean deliveries,” Patient Safety Network, 2022.
    1. Anderson, Deborah J.,
    2. Melissa Binder, and
    3. Kate Krause,
    “The Motherhood Wage Penalty Revisited: Experience, Heterogeneity, Work Effort, and Work-Schedule Flexibility,” Industrial and Labor Relations Review, 2003, 56 (2), 273–294.
    OpenUrlCrossRef
    1. Andresen, Martin Eckhoff and
    2. Emily Nix,
    “What causes the child penalty? Evidence from adopting and same-sex couples,” Journal of labor economics, 2022, 40 (4), 971–1004.
    OpenUrl
    1. Angolile, Cornel M,
    2. Baraka L Max,
    3. Justice Mushemba, and
    4. Harold L Mashauri,
    “Global increased cesarean section rates and public health implications: A call to action,” Health science reports, 2023, 6 (5), e1274.
    OpenUrl
    1. Antoine, Clarel and
    2. Bruce K Young,
    “Cesarean section one hundred years 1920–2020: the Good, the Bad and the Ugly,” Journal of perinatal Medicine, 2021, 49 (1), 5–16.
    OpenUrl
  2. Assistant Secretary for Planning and Evaluation, “Addressing the Maternal Health Crisis in the United States: An Update from the U.S. Department of Health and Human Services,” July 2024.
    1. Athey, Susan and
    2. Guido W Imbens,
    “Design-based analysis in difference-in-differences settings with staggered adoption,” Journal of Econometrics, 2022, 226 (1), 62–79.
    OpenUrlCrossRef
    1. Baicker, Katherine,
    2. Kasey S Buckles, and
    3. Amitabh Chandra,
    “Geographic variation in the appropriate use of cesarean delivery: do higher usage rates reflect medically inappropriate use of this procedure?,” Health Affairs, 2006, 25 (Suppl1), W355–W367.
    OpenUrlPubMed
    1. Belluz, Julia,
    “California decided it was tired of women bleeding to death in childbirth,” Vox, December 2017.
    1. Bögl, Sarah,
    2. Jasmin Moshfegh,
    3. Petra Persson, and
    4. Maria Polyakova,
    “The economics of infertility: Evidence from reproductive medicine,” Working Paper w32445, National Bureau of Economic Research 2024.
    1. Borusyak, Kirill,
    2. Xavier Jaravel, and
    3. Jann Spiess,
    “Revisiting event study designs: Robust and efficient estimation,” arXiv preprint arXiv:2108.12419, 2021.
    1. Callaway, Brantly and
    2. Pedro H. C. Sant’Anna,
    “Difference-in-Differences with multiple time periods,” Journal of Econometrics, 2021, 225 (2), 200–230.
    OpenUrlCrossRef
    1. Card, David,
    2. Alessandra Fenizia, and
    3. David Silver,
    “The health impacts of hospital delivery practices,” American Economic Journal: Economic Policy, 2023, 15 (2), 42–81.
    OpenUrl
    1. Casarico, Alessandra and
    2. Salvatore Lattanzio,
    “Behind the child penalty: understanding what contributes to the labour market costs of motherhood,” Journal of Population Economics, 2023, 36 (3), 1489–1511.
    OpenUrl
    1. Chaisemartin, Clément De and
    2. Xavier d’Haultfœuille,
    “Two-way fixed effects estimators with heterogeneous treatment effects,” American Economic Review, 2020, 110 (9), 2964–96.
    OpenUrlCrossRef
    1. Clark, Steven L,
    2. Michael A Belfort,
    3. Gary DV Hankins,
    4. Janet A Meyers, and
    5. Frank M Houser,
    “Variation in the rates of operative delivery in the United States,” American journal of obstetrics and gynecology, 2007, 196 (6), 526–e1.
    OpenUrlPubMedWeb of Science
    1. Corredor-Waldron, Adriana,
    2. Janet Currie, and
    3. Molly Schnell,
    “Drivers of racial differences in C-sections,” Working Paper w32891, National Bureau of Economic Research 2024.
    1. Costa-Ramón, Ana María,
    2. Ana Rodríguez-González,
    3. Miquel Serra-Burriel, and
    4. Carlos Campillo-Artero,
    “It’s about time: Cesarean sections and neonatal health,” Journal of health economics, 2018, 59, 46–59.
    OpenUrlPubMed
    1. Costa-Ramón, Ana,
    2. Mika Kortelainen,
    3. Ana Rodríguez-González, and
    4. Lauri Sääksvuori,
    “The longrun effects of cesarean sections,” Journal of Human Resources, 2022, 57 (6), 2048–2085.
    OpenUrlAbstract/FREE Full Text
    1. Currie, Janet and
    2. W Bentley MacLeod,
    “Diagnosing expertise: Human capital, decision making, and performance among physicians,” Journal of labor economics, 2017, 35 (1), 1–43.
    OpenUrlCrossRef
    1. Cutler, David M.,
    “The lifetime costs and benefits of medical technology,” Journal of Health Economics, December 2007, 26 (6), 1081–1100.
    OpenUrlCrossRefPubMedWeb of Science
    1. Deryugina, Tatyana and
    2. David Molitor,
    “The causal effects of place on health and longevity,” Journal of Economic Perspectives, 2021, 35 (4), 147–170.
    OpenUrlPubMed
    1. Ding, Hui,
    “Geographic Variation in Mental Health Treatment Utilization: Evidence from Migration,” American Economic Journal: Economic Policy, Forthcoming.
    1. Doyle, Joseph J.,
    2. John A. Graves,
    3. Jonathan Gruber, and
    4. Samuel A. Kleiner,
    “Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns,” Journal of Political Economy, February 2015, 123 (1), 170–214.
    OpenUrlCrossRefPubMed
    1. Eichmeyer, Sarah and
    2. Jonathan Zhang,
    “Pathways into opioid dependence: Evidence from practice variation in emergency departments,” American Economic Journal: Applied Economics, 2022, 14 (4), 271–300.
    OpenUrlCrossRef
    1. Finkelstein, Amy,
    2. Matthew Gentzkow, and
    3. Heidi Williams,
    “Sources of geographic variation in health care: Evidence from patient migration,” The quarterly journal of economics, 2016, 131 (4), 1681–1726.
    OpenUrlCrossRefPubMed
    1. Finkelstein, Amy,
    2. Matthew Gentzkow, and
    3. Heidi Williams,
    “Place-based drivers of mortality: Evidence from migration,” American Economic Review, 2021, 111 (8), 2697–2735.
    OpenUrlPubMed
    1. Fischer, Stefanie,
    2. Heather Royer, and
    3. Corey White,
    “Health Care Centralization: The Health Impacts of Obstetric Unit Closures in the United States,” American Economic Journal: Applied Economics, 2024, 16 (3), 113–141.
    OpenUrl
    1. Gallen, Yana,
    2. Juanna Schrøter Joensen,
    3. Eva Rye Johansen, and
    4. Gregory F Veramendi,
    “The Labor Market Returns to Delaying Pregnancy,” Available at SSRN 4554407, 2023.
    1. Gangl, Markus and
    2. Andrea Ziefle,
    “Motherhood, Labor Force Behavior, and Women’s Careers: An Empirical Assessment of the Wage Penalty for Motherhood in Britain, Germany, and the United States,” Demography, 2009, 46 (2), 341–369.
    OpenUrlCrossRefPubMedWeb of Science
    1. Gemmill, Alison,
    2. Molly Passarella,
    3. Ciaran S Phibbs,
    4. Elliott K Main,
    5. Scott A Lorch,
    6. Katy B Kozhimannil,
    7. Suzan L Carmichael, and
    8. Stephanie A Leonard,
    “Validity of birth certificate data compared with hospital discharge data in reporting maternal morbidity and disparities,” Obstetrics & Gynecology, 2022, pp. 10–1097.
    1. Goodman-Bacon, Andrew,
    “Difference-in-differences with variation in treatment timing,” Journal of Econometrics, 2021, 225 (2), 254–277.
    OpenUrlCrossRef
    1. Gunja, Munira Z.,
    2. Relebohile Gumas Evan D. and
    3. Masitha, and
    4. Laurie C. Zephyrin,
    “Insights into the U.S. Maternal Mortality Crisis: An International Comparison,” Issue Brief, The Commonwealth Fund June 2024.
    1. Halla, Martin,
    2. Harald Mayr,
    3. Gerald J. Pruckner, and
    4. Pilar García-Gómez,
    “Cutting fertility? Effects of cesarean deliveries on subsequent fertility and maternal labor supply,” Journal of Health Economics, 2020, 72, 102325.
    OpenUrlPubMed
    1. Hamilton, Brady E,
    2. Joyce A Martin, and
    3. Michelle JK Osterman,
    “Births: Provisional Data for 2023,” Technical Report 35, Centers for Disease Control and Prevention, NVSS Vital Statistics Rapid Release April 2024.
    1. Isen, Adam,
    2. Maya Rossin-Slater, and
    3. W Reed Walker,
    “Every Breath You Take—Every Dollar You’ll Make: The Long-Term Consequences of the Clean Air Act of 1970,” Journal of Political Economy, 2017, 125 (3), 848–902.
    OpenUrlCrossRef
    1. Jack, Rebecca,
    2. Daniel Tannenbaum, and
    3. Brenden Timpe,
    “The Parenthood Gap: Firms and Earnings Inequality After Kids,” 2025.
    1. Jensen, Vibeke Myrup and
    2. Miriam Wüst,
    “Can Caesarean section improve child and maternal health? The case of breech babies,” Journal of Health Economics, January 2015, 39, 289–302. Publisher: Elsevier BV.
    OpenUrlPubMed
    1. Kassebaum, Nicholas J,
    2. Ryan M Barber,
    3. Zulfiqar A Bhutta,
    4. Lalit Dandona,
    5. Peter W Gething,
    6. Simon I Hay,
    7. Yohannes Kinfu,
    8. Heidi J Larson,
    9. Xiaofeng Liang,
    10. Stephen S Lim
    et al. “Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015,” The Lancet, 2016, 388 (10053), 1775–1812.
    OpenUrl
    1. Keag, Oonagh E,
    2. Jane E Norman, and
    3. Sarah J Stock,
    “Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and metaanalysis,” PLoS medicine, 2018, 15 (1), e1002494.
    OpenUrl
    1. Kennedy-Moulton, Kate,
    2. Sarah Miller,
    3. Petra Persson, Maya Rossin-Slater,
    4. Laura R. Wherry, and
    5. Gloria Aldana,
    “Maternal and infant health inequality: New evidence from linked administrative data,” Review of Economics and Statistics, Forthcoming.
    1. Kissel, Helen and
    2. Helena Roy,
    “The Role of Providers in Variation in Cesarean Section Use,” 2025. Stanford University, unpublished manuscript.
    1. Kleven, Henrik,
    2. Camille Landais, and
    3. Gabriel Leite-Mariante,
    “The child penalty atlas,” Review of Economic Studies, 2024, p. rdae104.
    1. Kleven, Henrik,
    2. Camille Landais, and
    3. Jakob Egholt Søgaard,
    “Does biology drive child penalties? Evidence from biological and adoptive families,” American Economic Review: Insights, 2021, 3 (2), 183–198.
    OpenUrl
    1. Kozhimannil, Katy Backes,
    2. Michael R Law, and
    3. Beth A Virnig,
    “Cesarean delivery rates vary tenfold among US hospitals; reducing variation may address quality and cost issues,” Health Affairs, 2013, 32 (3), 527–535.
    OpenUrlAbstract/FREE Full Text
    1. Lundborg, Petter,
    2. Erik Plug, and
    3. Astrid Würtz Rasmussen,
    “Can women have children and a career? IV evidence from IVF treatments,” American Economic Review, 2017, 107 (6), 1611–1637.
    OpenUrlCrossRefPubMed
  3. Main, Elliott, January 2023. Personal Communication.
    1. Main, Elliott K,
    2. Ravi Dhurjati,
    3. Valerie Cape,
    4. Julie Vasher,
    5. Anisha Abreo,
    6. Shen-Chih Chang, and
    7. Jeffrey B Gould,
    “Improving maternal safety at scale with the mentor model of collaborative improvement,” The Joint Commission Journal on Quality and Patient Safety, 2018, 44 (5), 250–259.
    OpenUrl
    1. Main, Elliott K,
    2. Shen-Chih Chang,
    3. Valerie Cape,
    4. Christa Sakowski,
    5. Holly Smith, and
    6. Julie Vasher,
    “Safety assessment of a large-scale improvement collaborative to reduce nulliparous cesarean delivery rates,” Obstetrics & Gynecology, 2019, 133 (4), 613–623.
    OpenUrlCrossRefPubMed
    1. McClellan, Mark,
    “Does More Intensive Treatment of Acute Myocardial Infarction in the Elderly Reduce Mortality?: Analysis Using Instrumental Variables,” JAMA, September 1994, 272 (11), 859.
    OpenUrlCrossRefPubMedWeb of Science
    1. Mourot, Pauline,
    “Should Top Surgeons Practice at Top Hospitals? Sorting and Complementarities in Healthcare,” 2024. University of Chicago, unpublished manuscript.
    1. Mühlrad, Hanna,
    “Cesarean sections for high-risk births: health, fertility, and labor market outcomes*,” The Scandinavian Journal of Economics, October 2022, 124 (4), 1056–1086. Publisher: Wiley.
    OpenUrl
    1. Nielsen, Helena Skyt,
    2. Marianne Simonsen, and
    3. Mette Verner,
    “Does the Gap in Family-Friendly Policies Drive the Family Gap?,” The Scandinavian Journal of Economics, 2004, 106 (4), 721–744.
    OpenUrl
    1. Rambachan, Ashesh and
    2. Jonathan Roth,
    “A More Credible Approach to Parallel Trends,” The Review of Economic Studies, 02 2023, 90 (5), 2555–2591.
    OpenUrl
    1. Robinson, Sarah,
    2. Heather Royer, and
    3. David Silver,
    “Geographic variation in cesarean sections in the United States: Trends, correlates, and other interesting facts,” Journal of Labor Economics, 2024, 42 (S1), S219–S259.
    OpenUrlCrossRefPubMed
    1. Rogvi, Jessica Á,
    2. Aline Bütikofer,
    3. Lone Krebs,
    4. Hanna Mühlrad, and
    5. Miriam Wüst,
    “Cesarean Section, Childhood Health, and Schooling: Quasi-Experimental Evidence From Denmark, Norway and Sweden,” Health Economics, March 2025, 34 (3), 431–441. Publisher: Wiley.
    OpenUrlPubMed
    1. Rosenstein, Melissa G,
    2. Shen-Chih Chang,
    3. Christa Sakowski,
    4. Cathie Markow,
    5. Stephanie Teleki,
    6. Lance Lang,
    7. Julia Logan,
    8. Valerie Cape, and
    9. Elliott K Main,
    “Hospital quality improvement interventions, statewide policy initiatives, and rates of cesarean delivery for nulliparous, term, singleton, vertex births in California,” Jama, 2021, 325 (16), 1631–1639.
    OpenUrlCrossRefPubMed
    1. Roth, Jonathan,
    2. Pedro HC Sant’Anna,
    3. Alyssa Bilinski, and
    4. John Poe,
    “What’s trending in differencein-differences? A synthesis of the recent econometrics literature,” Journal of Econometrics, 2023, 235 (2), 2218–2244.
    OpenUrlCrossRef
    1. Sant’Anna, Pedro H.C. and
    2. Jun Zhao,
    “Doubly Robust Difference-in-Differences Estimators,” Journal of Econometrics, 2020, 219 (1), 101–22.
    OpenUrlCrossRef
    1. Singh, Manasvini,
    “Heuristics in the delivery room,” Science, 2021, 374 (6565), 324–329.
    OpenUrlPubMed
    1. Słabuszewska-Jóźwiak, Aneta,
    2. Jacek Krzysztof Szymański,
    3. Michał Ciebiera,
    4. Beata Sarecka-Hujar, and
    5. Grzegorz Jakiel,
    “Pediatrics consequences of caesarean section—a systematic review and metaanalysis,” International journal of environmental research and public health, 2020, 17 (21), 8031.
    OpenUrl
    1. Smith, Holly,
    2. Nancy Peterson,
    3. David Lagrew, and
    4. Elliott Main,
    “Toolkit to Support Vaginal Birth and Reduce Primary Cesareans: A Quality Improvement Toolkit.,” Technical Report, California Maternal Quality Care Collaborative 2016.
    1. Stenson, Jacqueline,
    “How hospitals in California lowered C-section rates for new mothers,” NBC News, May 2021.
    1. Stephenson, Joan,
    “Rate of first-time cesarean deliveries on the rise in the US,” in “JAMA Health Forum,” Vol. 3 American Medical Association 2022, pp. e222824–e222824.
    OpenUrlPubMed
    1. Sun, Liyang and
    2. Sarah Abraham,
    “Estimating dynamic treatment effects in event studies with heterogeneous treatment effects,” Journal of Econometrics, 2021, 225 (2), 175–199.
    OpenUrlCrossRef
    1. Tikkanen, Roosa,
    2. Munira Z Gunja,
    3. Molly FitzGerald, and
    4. Laurie Zephyrin,
    “Maternal mortality and maternity care in the United States compared to 10 other developed countries,” Issue briefs, Commonwealth Fund, 2020.
  4. U.S. Department of Health and Human Services, “Healthy People 2020 Midcourse Review,” 2017.
    1. VanGompel,
    2. Emily C White,
    3. Susan L Perez,
    4. Avisek Datta,
    5. Francesca R Carlock,
    6. Valerie Cape, and
    7. Elliott K Main,
    “Culture that facilitates change: a mixed methods study of hospitals engaged in reducing cesarean deliveries,” The Annals of Family Medicine, 2021, 19 (3), 249–257.
    OpenUrlAbstract/FREE Full Text
    1. Visser, L,
    2. C Slaager,
    3. BM Kazemier,
    4. AL Rietveld,
    5. MA Oudijk,
    6. CJM de Groot,
    7. BW Mol, and
    8. de Boer MA,
    “Risk of preterm birth after prior term cesarean,” BJOG: An International Journal of Obstetrics and Gynaecology, 2020, 127, 610–617.
    OpenUrl
    1. Williams, Corrine M,
    2. Ibitola Asaolu,
    3. Niraj R Chavan,
    4. Lucy H Williamson,
    5. Alysha M Lewis,
    6. Lauren Beaven, and
    7. Kristin B Ashford,
    “Previous cesarean delivery associated with subsequent preterm birth in the United States,” European Journal of Obstetrics & Gynecology and Reproductive Biology, 2018, 229, 88–93.
    OpenUrlPubMed
    1. Woolner, Andrea MF,
    2. Edwin Amalraj Raja,
    3. Sohinee Bhattacharya, and
    4. Mairead E. Black,
    “Risk of spontaneous preterm birth elevated after first cesarean delivery at full dilation: a retrospective cohort study of over 30,000 women,” American Journal of Obstetrics & Gynecology, 2024, 230 (3), 358.E1–358.E13.
    OpenUrl
    1. Yang, Q,
    2. SW Wen,
    3. L Oppenheimer,
    4. XK Chen,
    5. D Black,
    6. J Gao, and
    7. MC Walker,
    “Association of caesarean delivery for first birth with placenta praevia and placental abruption in second pregnancy,” BJOG: An International Journal of Obstetrics & Gynaecology, 2007, 114 (5), 609–613.
    OpenUrlPubMed
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The Labor Market and Health Impacts of Reducing Cesarean Section Deliveries
Sarah Miller, Petra Persson, Maya Rossin-Slater, Laura R. Wherry
Journal of Human Resources Sep 2026, 1025-14609R2; DOI: 10.3368/jhr.1025-14609R2

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The Labor Market and Health Impacts of Reducing Cesarean Section Deliveries
Sarah Miller, Petra Persson, Maya Rossin-Slater, Laura R. Wherry
Journal of Human Resources Sep 2026, 1025-14609R2; DOI: 10.3368/jhr.1025-14609R2
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Keywords

  • I14
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