Journal of Population Economics

, Volume 29, Issue 1, pp 5–37 | Cite as

Cesarean sections and subsequent fertility

  • Karen Norberg
  • Juan PantanoEmail author
Original Paper


Cesarean sections are rising all over the world and may, in some countries, soon become the most common delivery mode. A growing body of medical literature documents a robust fact: women undergoing cesarean sections end up having less children. Unlike most of the medical literature, which assumes that this association is mostly working through a physiological channel, we investigate a possible channel linking c-section and subsequent fertility through differences in maternal behavior after a c-section. Using several national and cross-national demographic data sources, we find evidence that maternal choice is playing an important role in shaping the negative association between cesarean section and subsequent fertility. In particular, we show that women are more likely to engage in active contraception after a cesarean delivery and conclude that intentional avoidance of subsequent pregnancies after a c-section seems to be responsible for part of the negative association between c-sections and subsequent fertility.


Fertility Infertility C-Sections Reproductive Health 

JEL Classification

J11 J13 I10 



We thank Qi (Clare) Li for truly outstanding research assistance. We also thank Kate Ambler, Marianne Bitler, Hoyt Bleakey, Kasey Buckles, Paul Gertler, Joe Hotz, Adriana Lleras-Muney, Bob Pollak, Seth Sanders, Lucie Schmidt, Michela Tincani, and participants at the Workshop on Work, Family and Public Policy at Washington University in St. Louis, the 2011 Meetings of the Midwest Economics Association in St. Louis, the Economic Demography Workshop at the 2011 PAA Meetings in Washington D.C., the 2011 joint meetings of LACEA and the Econometric Society in Santiago, Chile and the Economics and Biodemography of Aging and Health Workshop at the University of Chicago (2011). We also thank two anonymous referees for their helpful and insightful comments. All errors remain ours. We are grateful to the Center for Health Policy at Washington University in St. Louis as a source of support for Norberg during the writing of this paper. In addition, we gratefully acknowledge funding from the Weidenbaum Center at Washington University in St. Louis.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.National Bureau of Economic ResearchCambridgeUSA
  2. 2.Department of EconomicsWashington University in St. LouisSt. LouisUSA

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