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 São Paulo (Brazil), which increased women's autonomy to choose to deliver via C‐section 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. Since the law emphasizes women's autonomy, these results are consistent with mothers' demand being an important contributor to high C‐section rates in this context.