📢 NEW PUBLICATION ALERT!
A new article has just been published in Health Policy and Planning:
“Dynamic and heterogeneous impacts of granting and revoking elective c-section rights in São Paulo”
✍️ Authors: Gustavo Cordeiro, Judite Gonçalves, and Mylene Lagarde
This study examines the effects of a unique natural experiment in São Paulo, Brazil, where a 2019 law temporarily allowed pregnant women to opt for elective caesarean sections in public healthcare facilities, before being revoked less than a year later.
🔍 Key findings:
• The law led to an immediate 3.03 percentage point increase in c-section rates in public hospitals
• The effect was concentrated in the public sector, with no consistent changes in private or mixed hospitals
• After the law was revoked, c-section rates returned quickly to pre-policy levels, suggesting no lasting effects
• The largest increases were observed in municipalities with lower baseline c-section rates, greater reliance on public healthcare, and fewer health system resources
• The rise in c-sections was driven mainly by low-risk births and showed no detectable improvements in newborn health outcomes
• The additional procedures created an estimated fiscal burden of around R$459,000 for the public health system
🎯 Bottom line: While expanding women’s autonomy may appear empowering, this study shows that granting elective c-section rights without wider changes in clinical guidance or system incentives can increase the use of unnecessary, costlier procedures, particularly in already constrained public systems.
🔗 Read the full article here:
https://doi.org/10.1093/heapol/czag021