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Who benefits the most? Direct and indirect effects of a free cesarean section policy in Benin

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  • Selidji Caroline Tossou

Abstract

This paper evaluates the causal effect of the access to Benin's free cesarean section policy on females and their children. I use a large sample of Demographic and Health Surveys (DHS) for West African countries and analyze how the exemption of the cesarean section user fees for females in Benin directly impacts maternal and infant mortality, family size decisions, and labor market participation. I use a Difference in Differences approach and find that having access to the free cesarean section policy significantly reduces the number of stillbirths and infant mortality by 0.0855 (a 18.79 percentage change). Second, for the surviving children, I find that access to the free cesarean section increases the likelihood of maternal mortality by 0.00465 (a 5.21 percentage change). The policy is effective at reducing infant mortality and saving the newborn. However, it harms the mother's health which translates to lower fertility after the first birth and decreased maternal labor supply post-birth.

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  • Selidji Caroline Tossou, 2025. "Who benefits the most? Direct and indirect effects of a free cesarean section policy in Benin," Papers 2510.03658, arXiv.org.
    • Handle: RePEc:arx:papers:2510.03658
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    1. Marion Ravit & Martine Audibert & Valery Ridde & Myriam de Loenzien & Clémence Schantz & Alexandre Dumont, 2018. "Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa," Post-Print hal-01682919, HAL.
    2. Michael White & Salut Muhidin & Catherine Andrzejewski & Eva Tagoe & Rodney Knight & Holly Reed, 2008. "Urbanization and fertility: An event-history analysis of Coastal Ghana," Demography, Springer;Population Association of America (PAA), vol. 45(4), pages 803-816, November.
    3. Litorp, Helena & Mgaya, Andrew & Mbekenga, Columba K. & Kidanto, Hussein L. & Johnsdotter, Sara & Essén, Birgitta, 2015. "Fear, blame and transparency: Obstetric caregivers' rationales for high caesarean section rates in a low-resource setting," Social Science & Medicine, Elsevier, vol. 143(C), pages 232-240.
    4. Philip Ayizem Dalinjong & Alex Y. Wang & Caroline S. E. Homer, 2017. "The operations of the free maternal care policy and out of pocket payments during childbirth in rural Northern Ghana," Health Economics Review, Springer, vol. 7(1), pages 1-9, December.
    5. Francette Koechlin & Luca Lorenzoni & Paul Schreyer, 2010. "Comparing Price Levels of Hospital Services Across Countries: Results of Pilot Study," OECD Health Working Papers 53, OECD Publishing.
    6. Hill Kulu, 2013. "Why Do Fertility Levels Vary between Urban and Rural Areas?," Regional Studies, Taylor & Francis Journals, vol. 47(6), pages 895-912, June.
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