Black women in the United States are significantly more likely to undergo cesarean sections than white women—even when medical risk, hospital, and physician are the same. A recent study led by economist Molly Schnell at Northwestern’s Institute for Policy Research found that Black mothers were over 20% more likely to have a C-section, despite preferring vaginal birth and having no greater medical need.
“Our findings are another data point in a large and troubling literature showing how the U.S. healthcare system too often leaves certain mothers and certain patients behind,” Schnell said. The study analyzed birth records from New Jersey hospitals between 2008 and 2017 and ruled out common explanations like maternal preference or hospital differences.
One key insight: unscheduled C-sections were less likely when operating rooms were busy. But the drop was more pronounced for Black mothers, suggesting that doctors may have a lower threshold for performing surgery on them. Schnell noted that some physicians admitted to scheduling deliveries to manage their workload, with C-sections offering more control over timing.
Financial incentives also play a role. Doctors often earn more for surgical births, but Schnell cautioned against reducing payments across the board, which could limit access to necessary procedures.
Advocates like doulas may help. “Mothers are less likely to have C-sections when they have a doula,” Schnell said, pointing to Medicaid reimbursement policies as a promising area for reform.
See: “Why Are Black Women More Likely to Have C-Sections Than White Women?” (March 31, 2025)
