Do Cesarean Delivery rates rise when the economy declines? A test of the economic stress hypothesis

Laura Viluma

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A growing body of research supports the Barker hypothesis that adverse conditions around the time of birth have a negative effect on health. Nevertheless, the mechanisms linking early life conditions with health are still unclear. This paper investigates one of such potential mechanisms, specifically, ambient stress, by analyzing the effect of economic downturns as a stressor on the probability of Cesarean Delivery (CD). I focus particularly on male CD since the literature reports that male fetuses are more sensitive to stressors in utero than female fetuses. Using data from Lifelines, a large cohort study from the northern Netherlands, I show that the probability of CD for male babies increases when unemployment levels rise. This result suggests that maternal stress might be one of the mechanisms how early life economic conditions affect health.

Original languageEnglish
Article number100816
Pages (from-to)1-11
Number of pages11
JournalEconomics and Human Biology
Early online date7 Sept 2019
Publication statusPublished - Jan 2020


The author wishes to acknowledge the services of the LifeLines Cohort Study, the contributing research centres delivering data to LifeLines, and all the study participants. LifeLines is a multi-disciplinary prospective population-based cohort study examining in a unique three-generation design the health and health-related behaviours of 167,729 persons living in the North East region of The Netherlands. It employs a broad range of investigative procedures in assessing the biomedical, socio-demographic, behavioural, physical and psychological factors which contribute to the health and disease of the general population, with a special focus on multimorbidity. In addition, the LifeLines project comprises a number of cross-sectional sub-studies which investigate specific age-related conditions. These include investigations into metabolic and hormonal diseases, including obesity, cardiovascular and renal diseases, pulmonary diseases and allergy, cognitive function and depression, and musculoskeletal conditions. The LifeLines Cohort Study, and generation and management of GWAS genotype data for the LifeLines Cohort Study is supported by the Netherlands Organization of Scientific Research NWO (grant 175.010.2007.006 ), the Economic Structure Enhancing Fund (FES) of the Dutch government, the Ministry of Economic Affairs , the Ministry of Education, Culture and Science , the Ministry for Health, Welfare and Sports , the Northern Netherlands Collaboration of Provinces (SNN) , the Province of Groningen, University Medical Center Groningen , the University of Groningen , Dutch Kidney Foundation and Dutch Diabetes Research Foundation . This study was supported by the Netherlands Organisation for Scientific Research (NWO) and benefitted from comments received from the audiences at the EUHEA conference 2018, iHEA conference 2017 and the NIDI/RUG workshop on Socioeconomic differences and health in 2016. I thank Rob Alessie, Viola Angelini and Jochen Mierau for their helpful input in developing this study. Appendix A

FundersFunder number
Economic Structure Enhancing Fund
Ministry for Health, Welfare and Sports
Ministry of Education, Culture and Science
Netherlands Organization of Scientific Research NWO175.010.2007.006
Fusion Energy Sciences
Rijksuniversiteit Groningen
Ministerie van Volksgezondheid, Welzijn en Sport
Diabetes Fonds
Ministerie van Economische Zaken
Ministerie van Onderwijs, Cultuur en Wetenschap
Nederlandse Organisatie voor Wetenschappelijk Onderzoek


    • Cesarean Delivery
    • Cohort studies
    • Early-life conditions
    • Health
    • Stress
    • Unemployment


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