Association for Public Policy Analysis & Management

An early elective delivery refers to a cesarean or an induction performed before 39 weeks without any medical indication. The absence of medical indication suggests that the mother’s or the physician’s preferences regarding the method and timing of delivery were decisive. Over the last decade, there has been a nationwide effort in the U.S. to prevent early elective deliveries. These efforts successfully reduced the share of early elective deliveries, though the effects of this reduction on birth outcomes are not clearly established.

I estimate the effect of early elective deliveries on birth outcomes using Oregon’s statewide hard-stop policy in 2011 as an exogenous shock. The policy requires review and approval for any delivery before 39 weeks without any medical indication and decreased the share of early elective deliveries by at least 25 percent. To estimate the effect of this reduction on birth outcomes is challenging, because “the treatment group”, i.e. mothers who would have had an early elective delivery in the absence of the policy, is not observable. To overcome this challenge, I calculate the propensity of having an early elective delivery for each mother using mother and pregnancy characteristics. Then, I use this variation in propensities to identify the effect of the policy in a difference-in-differences setup.

I find that a decrease in early elective deliveries reduces the use of medication on the newborn at birth. One percentage point decline in early elective deliveries reduces surfactant use – a medication for respiratory distress syndrome - by 5.5 percent and antibiotic use for suspected neonatal sepsis by 2.9 percent. I also find suggestive evidence of a decline in Neonatal Intensive Care Admissions. My results support the nationwide effort to prevent early elective deliveries and display its potential in reducing healthcare costs and improving birth outcomes.