Racial Disparities in Cesarean Section Rates Between Non-Hispanic Black and Non-Hispanic White Populations in the United States

Abstract This study uses national natality data from the National Vital Statistics System, provided by the National Center for Health Statistics, covering the years 2011 to 2018 ( N = 23,810,031) to investigate racial disparities in cesarean section (C-section) rates between non-Hispanic Black and non-Hispanic White mothers in the United States. This analysis offers a comprehensive perspective on the factors contributing to C-section disparities by considering mothers' demographic characteristics, health conditions, and infant health status. Using multivariable logistic regression, the findings reveal consistently higher C-section rates for non-Hispanic Black mothers compared to non-Hispanic White mothers, with the gap widening over time. Even after adjusting for sociodemographic and health-related factors, non-Hispanic Black mothers remained more likely to undergo C-sections. Using Blinder-Oaxaca decomposition methods, key factors contributing to this C-section rates disparity include maternal age, the source of delivery payment, and fetal presentation. This study highlights the pressing need for further investigation into healthcare system factors and racial inequities driving these disparities, alongside the growing urgency for policy and practical interventions to reduce unnecessary C-sections.