Giving Birth While Facing Death: Cesarean Sections and Community Violence in Latin America

Abstract

Armed conflict and organized crime are known to be linked to numerous negative maternal and neonatal health outcomes, such as stillbirth, low birth weight, and neonatal mortality. This study investigates how exposure to lethal community violence during pregnancy correlates with Cesarean births in Latin America, a region characterized by high rates of both C-sections and violence. The analysis combines micro-level survey data, covering 123,503 births, with subnational homicide statistics from Colombia, the Dominican Republic, Guatemala, and Mexico. Region-fixed effects linear probability models were used to eliminate geographically varying omitted factors that could potentially confound exposure to violence and health conditions. The findings suggest that the high rates of C-sections in Latin America can partially be attributed to the high levels of violence, due to an increase in both medically unnecessary and emergency procedures. The relationship between exposure to community violence and C-section delivery varied by country, women’s socio-demographic characteristics, and the number of antenatal care visits. Exposure to violence during all trimesters correlated with the uptake of C-sections, indicating that violence negatively affects maternal and child health throughout pregnancy. This study enriches our understanding of the social determinants of maternal and child health. The findings can serve to inform comprehensive interventions aimed at reducing excess C-section rates and improving the health of women and newborns in areas affected by violence.