Cesarean sections and subsequent fertility

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.