Do non-Hispanic Black women have higher odds of a Cesarean delivery compared to other groups?

Research consistently shows that non-Hispanic Black women in the United States are more likely to have a cesarean delivery than women from other racial and ethnic groups. A large retrospective cohort study of over 41 million births from 2014 to 2024 found that after adjusting for factors like age, medical conditions, and insurance status, non-Hispanic Black women still had higher odds of cesarean delivery compared to non-Hispanic White women ³. This disparity persists even when accounting for known risk factors, suggesting that systemic and structural factors play a role.

What the research says

A major population-based study using U.S. birth certificate data from 2014 to 2024 analyzed over 41 million singleton live births and found that 32.0% were cesarean deliveries. After adjusting for maternal demographics, clinical factors, and insurance status, non-Hispanic Black women had significantly higher odds of cesarean delivery compared to non-Hispanic White women ³. The study also found that insurance type (e.g., Medicaid vs. private) independently affected cesarean rates, but racial disparities remained even within the same insurance categories ³.

Other research supports these findings. A study from a single U.S. institution found that among women with one previous cesarean, Hispanic women had higher odds of repeat cesarean delivery compared to non-Hispanic White women (adjusted odds ratio 2.48), but non-Hispanic Black women also had elevated odds, though the study focused on Hispanic ethnicity ⁶. Additionally, a study on cesarean complications found that non-Hispanic Black women had higher rates of severe maternal morbidity after cesarean delivery compared to non-Hispanic White women, even after adjusting for clinical factors ⁷.

While some studies examine other risk factors for cesarean delivery—such as prior gestational diabetes ¹, high intra-abdominal pressure ², or high prepregnancy BMI ⁴—these factors do not fully explain the racial disparities. The consistent finding across multiple studies is that non-Hispanic Black women face higher odds of cesarean delivery, pointing to underlying inequities in healthcare access, quality, and systemic bias ³⁶⁷.

What to ask your doctor

• What are my individual risk factors for cesarean delivery, and how do they compare to average rates for my racial/ethnic group?
• Can you explain how hospital policies or provider practices might influence cesarean rates, and whether there are options to reduce unnecessary cesareans?
• Are there any programs or resources at this hospital that address racial disparities in maternal health outcomes?
• How does my insurance coverage affect the likelihood of cesarean delivery, and are there alternatives I should consider?