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

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.