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Open Access Highly Accessed Research article

Economic downturns and male cesarean deliveries: a time-series test of the economic stress hypothesis

Tim A Bruckner1*, Yvonne W Cheng23, Amrita Singh1 and Aaron B Caughey45

Author Affiliations

1 Public Health & Planning, Policy and Design, University of California, Irvine, 202 Social Ecology I, Irvine, CA 92697-7075, USA

2 Center for Clinical and Policy Perinatal Research, University of California, San Francisco, 500 Parnassus Ave, San Francisco, California 94143, USA

3 Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 500 Parnassus Ave, San Francisco, California 94143, USA

4 Department of Obstetrics and Gynecology, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Portland, Oregon, USA

5 Center for Women’s Health, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Portland, Oregon 97239-3098, USA

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BMC Pregnancy and Childbirth 2014, 14:198  doi:10.1186/1471-2393-14-198

Published: 7 June 2014

Abstract

Background

In light of the recent Great Recession, increasing attention has focused on the health consequences of economic downturns. The perinatal literature does not converge on whether ambient economic declines threaten the health of cohorts in gestation. We set out to test the economic stress hypothesis that the monthly count of cesarean deliveries (CD), which may gauge the level of fetal distress in a population, rises after the economy declines. We focus on male CD since the literature reports that male more than female fetuses appear sensitive to stressors in utero.

Methods

We tested our ecological hypothesis in California for 228 months from January 1989 to December 2007, the most recent data available to us at the time of our tests. We used as the independent variable the Bureau of Labor Statistics unadjusted total state employment series. Time-series methods controlled for patterns of male CD over time. We also adjusted for the monthly count of female CD, which controls for well-characterized factors (e.g., medical-legal environment, changing risk profile of births) that affect CD but are shared across infant sex.

Results

Findings support the economic stress hypothesis in that male CD increases above its expected value one month after employment declines (employment coefficient = -24.09, standard error = 11.88, p = .04). Additional exploratory analyses at the metropolitan level indicate that findings in Los Angeles and Orange Counties appear to drive the State-level relation.

Conclusions

Contracting economies may perturb the health of male more than female fetuses sufficiently enough to warrant more CD. Male relative to female CD may sensitively gauge the cohort health of gestations.

Keywords:
Cesarean delivery; Economic stress; Fetal distress; Male sensitivity