Black mothers with uncomplicated pregnancies in New Jersey are 25 percent more likely to deliver by cesarean section than their White counterparts, even when medical risk factors suggest they should undergo the surgery less often. This striking disparity persists even when Black and White mothers receive care from the same physicians in the same hospitals.
The gap proves most pronounced among the lowest-risk pregnancies, where Black mothers are 162 percent more likely to have an intrapartum C-section than White mothers. Among the highest-risk deliveries, however, no racial difference exists in C-section rates.
Researchers analyzed nearly one million births in New Jersey from 2008 to 2017, finding that Black mothers averaged younger ages and had lower predicted medical need for C-sections than White mothers. Yet controlling for medical risk, insurance status, education, hospital, and physician only reduced the disparity by one-fifth.
The racial gap disappears under one specific condition: when hospitals face surgical resource constraints due to concurrent scheduled C-sections. During these periods, physicians reduce unnecessary procedures on low-risk Black mothers first, suggesting provider discretion rather than medical necessity drives the disparity.
These marginal C-sections carry consequences. When surgical capacity limits their use, infant admissions to neonatal intensive care units decrease among low-risk mothers of both races, while maternal health outcomes remain stable. The findings indicate that reducing discretionary C-sections among low-risk Black women could simultaneously address racial disparities and improve infant health.
See: “Drivers of Racial Differences in C-Sections” (January 1, 2026)
