Effects of anti-corruption campaigns on cesarean section rate: evidence from China

The excessive utilization of cesarean section (CS) has become a global concern, given the potential short-term and long-term detrimental effects for mothers and infants. Worldwide, the rate of CS continues to rise, but efforts to curtail unnecessary CS procedures have yielded limited success. By combining data from three resources, this study aims to estimate the effects of anti-corruption campaigns under the Xi administration on CS rates. We focus on Shanxi Province, a major coal-producing province in north-central China, with notoriety for the collusion between local politicians and business elites. Using the data from the China Corruption Investigation Dataset and data from publicly listed firms between 2013 and 2016, we found that anti-corruption campaigns significantly changed the social environment as firms' business entertainment spending experienced substantial reductions. Using discharge records from 137 public hospitals, we adopted an instrumental variable (IV) approach and found that the anti-corruption campaigns led to significant reductions in unnecessary CS rates. The reductions are bigger among patients with second or later deliveries. We also find that the anti-corruption campaigns changed behaviors of attending and resident physicians. Our results provide insights into strategies to reduce corrupt practices within the healthcare sector and implementing interventions to minimize the occurrence of CS among healthy women and newborns.