Despite progress in lowering overall cesarean section rates in the U.S. over the past decade, striking racial and ethnic disparities persist, with minority communities bearing a disproportionate burden. A retrospective study examining 30 million births between 2012 and 2021 found that non-Hispanic Black women had the highest risk for cesarean delivery, and the disparity compared to other groups grew wider during this period. In 2021, Black individuals had a cesarean rate of 30.9%, outpacing rates for Asian or Pacific Islanders, Hispanic women, and non-Hispanic whites.
Marie J. Boller, MD, who led the study, said, “What this tells me is we need to center the work that’s addressing these disparities in all of our quality improvement work in obstetrics.” The research revealed that even among women giving birth for the first time or those without a prior cesarean, these gaps remained, indicating persistent systemic issues.
The study’s data underscored how cesarean births, while sometimes essential, can lead to increased morbidity and mortality, especially for communities already facing health inequities. Efforts to address racism in healthcare have been made, but Boller emphasized the need to “get uncomfortable and dismantle racism wherever it’s evident” to reverse these troubling trends.
Other factors like advanced maternal age and higher body mass index were also associated with elevated cesarean risk, but the call for targeted, evidence-based interventions centered on Black women and other groups who have not yet seen benefits from overall improvements in cesarean delivery rates remains urgent.
See: “Racial Disparities in C-Sections Persist Despite Overall Decrease” (November 18, 2025)
