Despite an overall decline in cesarean deliveries across the United States, non-Hispanic Black women face increasingly higher rates of surgical births compared to other racial and ethnic groups, according to a comprehensive study examining 30 million births between 2012 and 2021.
The research revealed that Black women consistently experienced the highest cesarean rates throughout the study period. In 2012, their adjusted risk for cesarean delivery was 12% higher than other groups. By 2021, that disparity had grown, with Black women facing a 17% increased risk. This widening gap occurred even as cesarean rates among white and Hispanic women decreased slightly.
The disparity was particularly pronounced among women having their first baby. Black women giving birth for the first time had a 20% higher cesarean risk in 2012, which increased to 23% by 2021. Among women with previous vaginal births, Black mothers faced a 32% higher cesarean risk in 2012, a gap that persisted through 2021.
“Systemic racism in obstetrics continues to shape trends in cesarean births and must be addressed directly by quality improvement efforts,” the authors concluded. They emphasized that observed inequities stem from structural factors including implicit bias in clinical decision-making, exposure to chronic stress, and unequal access to healthcare—not individual patient characteristics.
The findings underscore that efforts to reduce unnecessary cesarean births over the past decade have not benefited Black women equally, highlighting the urgent need to directly address structural racism in maternal healthcare.
See: “Racial and Ethnic Disparities in Cesarean Birth Trends in the United States” (November 17, 2025)
