Mode of First Delivery and Later Fertility and Fecundity: Evidence from Ten Demographic and Health Surveys

Sara Riese, ICF Macro

Cesarean section rates are increasing globally. While this intervention can be life-saving, there can be longer term implications for women. Previous studies show a negative association between cesarean section and subsequent fertility (live birth) and fecundity (pregnancy) in high-income settings. Prior research in this area from low- and middle-income settings has been limited to subsequent fertility due to data limitations. Additionally, this question has only been explored in sub-Saharan Africa. Using updates from the latest round of the DHS, we analyzed the association between mode of first birth and both subsequent fertility and fecundity in three countries in Asia and seven in sub-Saharan Africa. We find that in four of the ten countries, most in sub-Saharan Africa, there is a significant association between mode of first birth and both not having a subsequent pregnancy or a subsequent birth. Magnitude of associations between mode of first delivery and fertility and fecundity were similar, indicating that the effect of having a cesarean section at first birth on subsequent fertility is likely acting through limiting a woman’s ability to carry a subsequent pregnancy to term, and not on a woman’s subsequent ability to get pregnant.

Keywords: Fertility, Sexual and Reproductive Health and Rights

See extended abstract.