Unscheduled C-Sections Higher Among Black Women

by Jeroslyn JoVonn

October 15, 2024

‘The findings from the new study are alarming—it is concerning that these disparities exist and are so stark.’

A recent study shows that pregnant Black women are 25% more likely than white women to have cesarean section deliveries.

Research from the National Bureau of Economic Research reveals that from 2008 to 2017, 21% of Black women in New Jersey with unscheduled deliveries had C-sections, compared to 17% of white women in similar circumstances. Researchers suggest that this disparity may be driven more by provider preferences than by the individual needs of the mothers.

The disparity narrowed somewhat when researchers accounted for medical risk factors, sociodemographic characteristics, hospitals, and medical practice groups. However, it disappeared completely when adjusting for the availability of facilities—specifically, when scheduled C-sections were happening at a hospital, the racial gap in unscheduled C-sections between Black and white women nearly vanished.

“What we show is that it’s not likely this disparity is coming from something the physician is seeing that we—the researchers—are not seeing in the medical records,” Adriana Corredor-Waldron, assistant professor of economics, who co-authored the research paper, said.

“Because if Black mothers were truly better candidates for these unscheduled C-sections, we should see the gap persist, whether the operating rooms are busy or not.”

The study examined nearly 1 million births across 68 New Jersey hospitals, with researchers suggesting that implicit racial bias among providers may contribute to the disparity. They also noted that some hospitals might have a “financial incentive” to keep operating rooms occupied.

“The findings from the new study are alarming—it is concerning that these disparities exist and are so stark,” Mark Simon, M.D., chief medical officer at Ob Hospitalist Group (OBHG), told Healthline.

“The CDC has released dataTrusted Source that clearly highlights national differences in C-section rates across each state, with New Jersey ranking on the high end,” Simon added. “But this problem is not unique to New Jersey—disparities in maternal mortality, particularly along racial and socioeconomic lines, are also well-documented.”

The rate of cesarean deliveries has risen in the United States in recent years. Many of these procedures are scheduled ahead of time, raising concerns among experts about their medical necessity. Planned and unplanned C-sections now account for approximately one in three births in the U.S., significantly exceeding the World Health Organization’s (WHO) recommended target rate of 10–15%.

As highlighted by the new research, this trend disproportionately affects Black women, although the reasons behind this disparity remain unclear.

“We don’t have the data to go into detail on exactly what it is, whether it’s lack of patience, for example, or if it’s cultural misunderstandings between a physician and a person from a different race. We don’t have good data to answer that,” Corredor-Waldron said.

“What we can say, because we’ve talked with some ob-gyns, is that they think about things like perceived risk,” Corredor-Waldron added. “We’re all reading the (Centers for Disease Control reports) about high infant mortality among Black infants. It might be that the physician thinks, ‘I don’t want any complications. So I’m just going to go ahead and do an emergency C-section.’”