title: Economic downturns and male cesarean deliveries: a time-series test of the economic stress hypothesis.
abstract: BACKGROUND
  In light of the recent Great Recession, increasing attention has focused on the health consequences of economic downturns. The perinatal literature does not converge on whether ambient economic declines threaten the health of cohorts in gestation. We set out to test the economic stress hypothesis that the monthly count of cesarean deliveries (CD), which may gauge the level of fetal distress in a population, rises after the economy declines. We focus on male CD since the literature reports that male more than female fetuses appear sensitive to stressors in utero.
  
  
  METHODS
  We tested our ecological hypothesis in California for 228 months from January 1989 to December 2007, the most recent data available to us at the time of our tests. We used as the independent variable the Bureau of Labor Statistics unadjusted total state employment series. Time-series methods controlled for patterns of male CD over time. We also adjusted for the monthly count of female CD, which controls for well-characterized factors (e.g., medical-legal environment, changing risk profile of births) that affect CD but are shared across infant sex.
  
  
  RESULTS
  Findings support the economic stress hypothesis in that male CD increases above its expected value one month after employment declines (employment coefficient = -24.09, standard error = 11.88, p = .04). Additional exploratory analyses at the metropolitan level indicate that findings in Los Angeles and Orange Counties appear to drive the State-level relation.
  
  
  CONCLUSIONS
  Contracting economies may perturb the health of male more than female fetuses sufficiently enough to warrant more CD. Male relative to female CD may sensitively gauge the cohort health of gestations.
authors.affiliation: Public Health & Planning, Policy and Design, University of California, Irvine, 202 Social Ecology I, Irvine, CA 92697-7075, USA. tim.bruckner@uci.edu.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Bruckner
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Cheng
authors.forename: Amrita
authors.initials: A
authors.lastname: Singh
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D002585:Cesarean Section / Q000706:statistics & numerical data* / Q000639:trends; D057172:Economic Recession; D005260:Female; D005316:Fetal Distress / Q000209:etiology / Q000523:psychology*; D006801:Humans; D050498:Live Birth; D008297:Male; D011247:Pregnancy; D012737:Sex Factors; D012744:Sex Ratio; D013315:Stress, Psychological / Q000209:etiology*; D014478:Unemployment / Q000523:psychology* / Q000639:trends; D055815:Young Adult