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25-04-2024 | Sectio Caesarea | ORIGINAL RESEARCH

Cesarean Sections and Family Planning Among Ultra-Orthodox Israeli Jews

Authors: Yuval Arbel, Ronen Bar-El

Published in: Journal of Religion and Health

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Abstract

The elevated frequency of Cesarean sections (C-sections) in OECD countries not only burdens health systems financially but also heightens the risks for mothers and infants. This study explores the feasibility of reducing C-section rates by examining the Israeli ultra-Orthodox population, noted for its large families and low C-section rates. We analyze birth data from an Israeli hospital, focusing on ultra-Orthodox mothers with husbands who are yeshiva students compared to other mothers. Our findings reveal that all else being equal, mothers married to yeshiva students exhibit a lower likelihood of undergoing a C-section and a higher propensity to seek private medical services to avoid this procedure. This behavior is attributed to their preference for large families and the desire to minimize C-sections, which may restrict the number of possible future pregnancies. These insights underscore the potential effectiveness of initiatives encouraging mothers to opt for vaginal deliveries, thereby reducing healthcare costs and maternal-infant risks.
Appendix
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Footnotes
1
The cost of a C-section in the USA ranges from $13,143.4 to $28,637.34, while the cost of a vaginal delivery ranges from $9,516.86 to $20,243.38 (Hoffower & Borden 2019), and in most OECD countries, the cost of a caesarean delivery is twice the cost of a vaginal delivery (OECD, 2019).
 
2
See, for example, Caughey et al. (2014), Keag et al. (2018), Steer & Modi (2009), Talaulikar and Arulkumaran (2015), Timor-Tritsch and Monteagudo (2012), Villar et al. (2007), and Costa-Ramón et al. (2018).
 
3
See Currie and MacLeod (2008), Kessler and McClellan (2002), Rock (1988), and Shurtz (2013, 2014).
 
4
See Allin et al. (2019), Brekke et al. (2017), Burkhard et al. (2019), Celhay et al. (2019), Chalkley and Listl (2018), and Clemens and Gottlieb (2014).
 
5
Israel is a high-income country with an advanced healthcare system (Muhsen et al., 2017) and offers broad, publicly financed universal healthcare insurance for all its citizens by law (Porath & Lev, 1995). Israeli women may choose from twenty-seven publicly financed, highly rated medical birthing centers (OECD, 2019).
 
6
Orthodox Judaism adheres to the interpretation and application of the laws in the Torah as interpreted in the Talmud (the “Oral Law”) and further developed and applied by later authorities. The differences between Orthodox and ultra-Orthodox Judaism relate primarily to religious attitudes and evaluation of modernity and Zionism.
 
7
In 2018, the rate of C-sections in Israel spanned from 4.8 to 27.4%, with an average of 17.4%. Notably, the four medical centers predominantly serving the ultra-Orthodox community reported the lowest incidence of C-sections, registering under 10% of all deliveries (Yinon, 2021).
 
8
A yeshiva is a Jewish religious educational institution focused on the study of traditional Jewish religious texts. A “kollel” is a yeshiva for full-time, advanced study of the Talmud and rabbinic literature. Unlike a yeshiva, kollel students are mostly married men. A kollel pays a regular monthly stipend to its members. Jewish women are not obligated to study religious texts and are not allowed to study in a men's yeshiva or kollel.
 
9
See also Arbel et al. (2019a; 2019b), Arbel et al. (2014).
 
10
STEM stands for Science, Technology, Engineering, and Mathematics.
 
11
only 51% of ultra-Orthodox males and 76% of ultra-Orthodox females participate in the labor market (compared to 87% and 83% of the general population). The average salary of ultra-Orthodox men in 2017 was approximately 55% of non-ultra-Orthodox Jewish men (8,467 NIS compared to 15,327 NIS), while the average salary of ultra-Orthodox women in 2017 was approximately 75.8% of non-ultra-Orthodox Jewish women (7257 NIS compared to 9928 NIS).
 
12
On the effect of state subsidies on the fertility rate of ultra-Orthodox Jews in Israel, see Cohen et al. (2013).
 
13
It should be noted that most of the deliveries in Israel are publicly financed and as mentioned above, the medical outcomes of the Israeli public medicine are considered very good, that is, a woman is not risking herself or the baby by using public medicine.
 
14
Note that with the exception of life-threatening emergencies, travel by vehicle is strictly prohibited during Jewish holidays and Saturdays.
 
15
We explain the procedure in Appendix 10 and present the results in Appendices 11 (the dependent variable is Cesarean) and 12 (the dependent variable is PMS).
 
16
See for example, Sher et al. (2003); Demir and Yıldırım (2019); Bakst et al. (2019); Illueca and Doolittle, (2020); Simhi et al. (2020); Piccinini et al. (2021).
 
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Metadata
Title
Cesarean Sections and Family Planning Among Ultra-Orthodox Israeli Jews
Authors
Yuval Arbel
Ronen Bar-El
Publication date
25-04-2024
Publisher
Springer US
Published in
Journal of Religion and Health
Print ISSN: 0022-4197
Electronic ISSN: 1573-6571
DOI
https://doi.org/10.1007/s10943-024-02026-3