We wanted to look at medically appropriate cesarean delivery rates by race and age, so we obtained data for 1.6 million childbirth hospitalizations in New Jersey over 15 years. There was a surge in cesareans around the early 2000s, and New Jersey was among the states with the highest rates.  New Jersey also had the highest Black maternal mortality rate among all states in recent years. 

Overall, the probability of giving birth via cesarean among low-risk Black patients was greater than that for White patients. Clinical need didn’t seem to play a role—in fact, Black women with low-risk pregnancies tended to get more cesareans, while those with high-risk pregnancies were less likely to get them than their White counterparts. Most of that misalignment of care occurred among Black patients from age 35 to 39. They had less chance of getting cesareans despite having clinical diagnoses that would indicate need.  

We’re not able to pinpoint one specific explanation for this extremely worrisome, and racialized pattern in cesarean use. The reason could be related to financial incentives: Insurers reimburse more for cesarians than for vaginal births. Physician discretion may also play a role, and that could be where the racial bias is. These findings tell us that hospitals need to be monitored on their use of cesareans by race and age.