Widening Racial Disparity in Cesarean Births Harm Black Families
Cesarean births in the United States are revealing “striking racial and ethnic disparities,” with Black mothers facing the steepest and most persistent gaps, according to maternal-fetal medicine specialist Marie Boller, MD. While national cesarean rates plateaued and even declined slightly between 2012 and 2021, Black mothers started the decade with higher cesarean rates and saw the disparity grow even larger by 2021, signaling that national progress has not been shared equitably.
Boller’s team examined cesarean trends over nearly a decade, stratifying results by parity to account for how prior births shape cesarean risk. She emphasized that cesarean delivery is often safe, necessary, and life-saving, yet it is also major abdominal surgery with heightened risks of hemorrhage and infection in the immediate postpartum period. Those risks do not end with discharge: a first-time cesarean substantially increases the likelihood of repeat cesareans, placenta accreta spectrum, and other serious complications in future pregnancies, turning primary cesarean disparities into long-term reproductive health inequities for communities of color.
Boller stressed that cesarean rates are just one piece of broader racial disparities in maternal morbidity and mortality, and that meaningful solutions must start far “upstream” from the delivery room. She called for better access to high-quality preconception and prenatal care and targeted investment in disproportionately affected communities, particularly Black communities. Clinician-side factors, including implicit bias and structural racism, also shape decisions and outcomes, making patient-centered care—where race never drives clinical rationale and patients are fully engaged in individualized plans—essential to closing these gaps.
See: “Marie Boller, MD, highlights racial gaps in cesarean birth” (November 25, 2025)
