Unequal motherhood: Racial-ethnic and socioeconomic disparities in cesarean sections in the United States

Disparities in cesarean rates in the United States represent an important social problem because cesareans are related to maternal deaths and to the high cost of American health care. There are pervasive racial-ethnic and socioeconomic disparities in maternity care as in health care more generally, yet there has been little scrutiny of how overuse of cesarean deliveries might be linked to these disparities. There are at least two possibilities when it comes to c-sections: black, Hispanic, Native American, and low socioeconomic status (SES) mothers could be less likely to have needed cesareans, leading to more negative outcomes for both mothers and babies, or they could be more likely to have medically unnecessary cesareans, leading to more negative outcomes as a result of the surgery itself. This research uses data on all recorded births in the United States in 2006 to analyze differences in the odds of a cesarean delivery by race-ethnicity and SES. The analysis reveals that non-Hispanic black, Hispanic/Latina, and Native American mothers are more likely to have cesarean deliveries than non-Hispanic white or Asian mothers. Also, after accounting for medical indications, increasing education is associated with a decline in odds of a cesarean delivery, especially for non- Hispanic whites. The results suggest that high cesarean rates are an indicator of low-quality maternity care, and that women with racial and socioeconomic advantages use them to avoid medically unnecessary cesarean deliveries rather than to request them.