A comprehensive study of over 30 million births in the United States reveals troubling trends in cesarean delivery rates among different racial and ethnic groups. While overall cesarean rates decreased slightly from 2012 to 2021, the disparities affecting non-Hispanic Black individuals not only persisted but actually worsened over this decade.
Researchers analyzing national birth data found that non-Hispanic Black women faced significantly higher risks of cesarean birth compared to other racial groups. The adjusted risk ratio increased from 1.12 in 2012 to 1.17 in 2021, indicating a widening gap. This disparity was particularly pronounced among first-time mothers and those without previous cesarean deliveries.
The study examined singleton, full-term births with vertex presentation, controlling for factors like maternal age, education, insurance status, body mass index, diabetes, and hypertension. Even after accounting for these variables, Black women consistently experienced elevated cesarean rates. Marie J Boller, the lead researcher, noted that these findings demonstrate how “systemic racism in obstetrics continues to shape trends in cesarean births.”
The research suggests that structural factors drive these inequities, including implicit bias in clinical decision-making, unequal access to healthcare, and the effects of historical redlining and environmental inequality. Notably, the study period coincided with the use of a vaginal birth after cesarean calculator that included race as a variable, potentially contributing to disparate treatment recommendations until its removal in 2021.
The authors emphasize that addressing these disparities requires confronting systemic racism directly through quality improvement efforts and policy changes at federal, state, and institutional levels.
See: “Racial and Ethnic Disparities in Cesarean Birth Trends in the United States” (November 17, 2025)
