Cesarean sections: Use or abuse?

The cesarean rate in Italy is about 34%, higher than in other European countries and in the United States. It has been rising dramatically over the past decades and it varies considerably across geographical areas. I show that such geographical variation is not driven by medical need and that higher cesarean rates are achieved by performing the procedure on less and less appropriate patients. I find no evidence that high-use areas develop higher ability in performing cesareans. Finally, by using both panel data analysis and instrumental variables, I show that there is no significant relation between risk-adjusted cesarean rates and maternal and neonatal mortality. The combined evidence in this paper suggests that lowering cesarean rates would likely affect less appropriate patients, would not have negative spillovers in terms of quality of the procedure and would not affect neonatal nor maternal mortality. JEL Classification: I1, H42.