The impact of family leave laws on cesarean delivery

Abstract

Cesarean rates have increased dramatically since 1965, with nearly a third of all births being delivered by cesarean section in 2006. Although numerous factors have contributed to this increase, this paper estimates the impact of family leave laws on cesarean rates. Leave laws led to increased health insurance coverage, thus altering the financial incentives facing both parents and physicians in the choice of delivery method. The laws also changed leave taking by parents, which may have impacted cesarean rates. The impact of leave laws on cesarean rates is estimated using a difference-in-differences approach coupled with the variation in state leave laws that existed prior to the passage of the federal Family and Medical Leave Act (FMLA) in 1993. The empirical results suggest that state leave laws are associated with an 8 to 13 percentage point reduction in the probability of cesarean delivery, but that the FMLA had little impact on cesarean rates.