Cesarean Section and Children’s Health: Evidence using a Quasi-Experimental Design

The prevalence of inflammatory child health conditions, such as asthma, eczema and food allergy, as well as neurodevelopmental conditions such as attention-deficit disorder and autism, and their associated costs have increased rapidly over the last 20 years, becoming public health and policy concerns. While environmental factors likely underpin these increases, recent studies rely only on associational methods. Cesarean section as a method of obstetric delivery is an understudied environmental factor that increased dramatically in the period of interest, and has been linked to child health outcomes via multiple biological mechanisms. We combine 22 years of birth cohort data from the National Survey of Children’s Health with cesarean section rates generated for subgroups based on state, sex, race, and Hispanic-origin. Then, we employ a quasi-experimental fixed effects design to estimate the effects of cesarean section on rates of asthma, eczema, food allergy, attention-deficit disorder and autism. We find that cesarean section significantly predicts food allergy and autism, with qualitatively impactful implications for each.