New Research Reveals Worsening Racial Disparities in Cesarean Births Across the United States

A new national study has brought renewed attention to a long-standing concern in maternal health: the persistent and widening racial disparities in cesarean birth rates. Researchers at Oregon Health & Science University’s Center for Women’s Health analyzed more than 30 million U.S. births from 2012 to 2021, uncovering clear patterns that show Black birthing individuals continue to face a significantly higher likelihood of cesarean delivery compared with every other racial and ethnic group. What makes this even more troubling is that the gap is growing, despite nationwide efforts over the past decade to reduce unnecessary cesarean procedures.

The overall U.S. cesarean rate has dipped only slightly since 2014, when major guidelines were introduced by the American College of Obstetrics and Gynecology to safely encourage vaginal births. But the decline has not been shared equally. For Black individuals, the rate has actually increased, compounding an already elevated risk.

The study reports that after adjusting for all medically relevant factors, the risk of cesarean birth for Black individuals was 12% higher in 2012 and 17% higher in 2021 than for other racial and ethnic groups. These disparities held true across different birthing situations. Among first-time births, the cesarean risk for Black individuals was 20% higher in 2012 and 23% higher in 2021. For those who had given birth vaginally before and had no previous cesarean, the risk was 32% higher in 2012 and 33% higher in 2021.

Researchers emphasize that the disparities have no biological basis. In medicine, cesarean deliveries are intended to be performed only when medically necessary, not influenced by race or ethnicity. The fact that racial gaps remain even after medical indicators are accounted for strongly suggests the influence of structural racism, including issues like inequitable care practices, systemic biases, and different treatment approaches that accumulate over time.

The study’s authors point out that while cesarean deliveries are often essential and lifesaving, unnecessary procedures carry increased risks. These include longer recovery times, higher rates of infection, complications in future pregnancies, and increased chances of severe maternal morbidity. When one racial group consistently receives more cesareans—especially in cases where medical conditions do not explain the difference—it signals a deeper systemic issue in how care is delivered.

Understanding the Broader Maternal Health Context

The findings are part of a much larger picture of maternal health inequity in the United States. Black birthing individuals face disproportionately high rates of pregnancy-related deaths, which remain several times higher than those of White individuals. Black infants are also more likely to be born preterm or face health complications tied to birth circumstances.

Experts frequently connect these disparities to structural issues such as unequal access to quality prenatal care, chronic stress caused by racism, and the effects of implicit bias—the automatic, unintentional stereotypes or assumptions that may influence clinical decisions. While health-care providers may not consciously intend to provide different care, decades of research show that bias can subtly affect how symptoms are interpreted, how concerns are addressed, and how medical decisions are made.

The OHSU study reinforces the need to address these biases head-on. Hospitals and health systems, according to the researchers, must incorporate routine education and self-evaluation practices into their clinical culture. OHSU, for example, reviews every cesarean case individually so clinicians can discuss why the procedure was necessary and evaluate whether different approaches might lead to more equitable outcomes.

Why Cesarean Disparities Matter

The goal is not to reduce cesarean numbers indiscriminately. Cesareans are often the safest choice for parent and baby. The issue arises when the distribution of those procedures falls unevenly across racial groups without a valid medical explanation.

Higher cesarean rates among Black birthing individuals reflect broader systemic inequities and contribute to long-term health risks. Excessive or avoidable cesareans can affect not just the current birth but all future pregnancies, raising the risk of complications such as uterine rupture or placenta previa.

Addressing these concerns requires a combination of direct clinical action and broader social investment. At the clinical level, this includes consistent bias training, equitable care protocols, and structured evaluations of cesarean decision-making. At the community and policy levels, solutions include building a more diverse health-care workforce, improving pathways into medical careers for underrepresented groups, and supporting community-based maternal health programs that have shown success in improving outcomes.

How Structural Racism Shapes Birth Outcomes

The researchers hope their work fuels deeper national discussions about equity in maternal care. Structural racism does not refer only to interpersonal discrimination; it includes how health systems are organized, how resources are allocated, and how historical disadvantages continue to shape outcomes today.

For example, hospitals that serve predominantly Black communities often face resource shortages, staffing limitations, or fewer access points for specialty care. Meanwhile, differences in social determinants—such as access to nutritious food, stable housing, and consistent medical care—can add layers of complexity to each pregnancy.

But importantly, the study’s findings show that even when controlling for these factors, the disparity still persists, pointing to systemic patterns within health care itself rather than external circumstances alone.

Moving Toward Solutions

Improving maternal health outcomes for Black birthing individuals requires multi-layered change. According to the researchers, health systems should:

Build quality improvement programs focused specifically on reducing unnecessary cesareans.
Address implicit bias through continuous training.
Ensure case-by-case review of cesarean decisions.
Support preconception and prenatal health through upstream interventions.
Improve workforce diversity to ensure care teams better reflect the communities they serve.

These efforts acknowledge that lowering cesarean rates happens one patient at a time. Health-care providers must remain attentive, collaborative, and open to improvement. Even small shifts in communication, listening, and care coordination can influence outcomes.

Additional Insight: Why This Research Matters Now

Maternal health has been a growing national concern for years, as the United States continues to have some of the highest maternal mortality rates among high-income countries. Racial disparities amplify the urgency. Studies like this one not only expose hidden patterns but help direct future policies, training programs, and health-system reforms.

Moreover, cesarean trends often act as indicators of deeper issues in maternity care. When one group consistently experiences higher rates—especially in medically similar situations—it signals that equity in care has not yet been achieved.

This research also encourages future studies to investigate the hospital-level factors that might drive cesarean decisions, such as staffing ratios, triage practices, access to midwifery care, or institutional culture. A comprehensive approach can help ensure that all birthing individuals receive care that is safe, respectful, and equitable.

Research Reference

JAMA Network Open – Racial and Ethnic Disparities in Cesarean Birth Trends in the United States (2025)
https://doi.org/10.1001/jamanetworkopen.2025.44078