Objective

To test the hypothesis that declining fertility would affect the number of cesarean sections (c-sections) on maternal demand, but not medically indicated c-sections.

Data Sources

The 1996-2004 National Health Insurance Research Database in Taiwan for all singleton deliveries.

Study Design

Retrospective population-based, longitudinal study. Estimation was performed using multinomial probit models.

Principal Findings

Results revealed that declining fertility had a significant positive effect on the probability of having a c-section on maternal request but not medically indicated c-section.

Conclusions

Our findings offer a precautionary note to countries experiencing a fertility decline. Policies to contain the rise of c-sections should understand the role of women's preferences, especially regarding cesarean deliveries on maternal request.