A Systematic Review of Racial and Ethnic Disparities in Cesarean Sections in the United States

Purpose: To evaluate what is known about the variation in cesarean delivery rates by race and ethnicity in the United States (US) in order to identify trends, gaps in knowledge, and directions for future research. Background: Cesarean sections (CS) are the most common surgical procedure for women in the US. Of the over 4 million births a year, one in three is now delivered in this manner and the risk adjusted prevalence rates appear to vary by race and ethnicity. However, data from individual studies provides limited or contradictory information on race and ethnicity as an independent predictor of delivery mode. Methods: A systematic review of the scientific literature was conducted. Peer-reviewed observational studies, published from 1995 to 2011, that contained comparative analyses of CS rates among two or more racial/ethnic groups were examined. Data were analyzed descriptively and where possible, meta-analyzed. Results: Twenty-five studies met the inclusion criteria. The patterns of findings suggest that certain racially and ethnically defined populations are at greater odds of cesarean while others have equivalent or lower risk adjusted rates. Disproportionately higher risk-adjusted rates are consistently seen among black and/or African American women relative to white non-Hispanic women although heterogeneity among studies was a limiting factor. Conclusion and Implications: Studies are needed to understand the mechanisms by which race and ethnicity differentially influence CS rates. Public health nurses are positioned to target interventions aimed at reducing disparities in CS through surveillance, birth preparation classes, and implementation of evidenced based guidelines.