Marie Boller, MD, highlights racial gaps in cesarean birth

In a recent discussion with Contemporary OB/GYN, Marie Boller, MD, maternal-fetal medicine specialist at Oregon Health & Science University, highlighted persistent and widening racial disparities in cesarean birth rates in the United States.

Her team’s study examined national cesarean trends from 2012 to 2021, stratifying results by parity to account for how prior births influence cesarean risk. While the overall US cesarean rate plateaued—and even declined slightly—during this period, the data revealed “striking racial and ethnic disparities.” Black birthing people not only had higher cesarean rates at the beginning of the study but experienced an even greater disparity by 2021, indicating that national improvements have not been shared equitably.

Boller emphasized that cesarean delivery is often a safe, necessary, and life-saving procedure, but it carries important short- and long-term health implications. In the immediate postpartum period, a cesarean involves major abdominal surgery, which increases risks such as hemorrhage and infection. However, the consequences extend well beyond the index pregnancy. A first-time cesarean substantially raises the likelihood of repeat cesareans in future pregnancies, along with increased risks of placenta accreta spectrum and other serious complications. For this reason, persistent disparities in primary cesarean rates also translate into long-term reproductive health inequities.

Addressing these gaps, Boller noted, requires interventions far “upstream” from the labor and delivery room. She stressed that cesarean rates are only one component of broader racial disparities in maternal morbidity and mortality. Solutions must include improving access to—and the quality of—preconception and prenatal care, as well as targeted investment in communities disproportionately affected, particularly Black birthing communities. Boller also highlighted the significant role of clinician-side factors, including implicit bias and structural racism within the health care system, which can influence decision-making and drive unequal outcomes.

Patient-centered care, she explained, is essential for improving birth outcomes and ensuring that cesarean decisions are made for the right reasons. Care plans must be individualized, with patients meaningfully involved in conversations about their options. While cesarean delivery is the safest choice for many births, race should never influence the clinical rationale, as there is no biological basis for racial differences in cesarean need.

Boller concluded by reiterating that although national cesarean rates have declined, Black birthing people have not experienced this progress. She views the findings as a call to action and remains committed to advancing research and care strategies aimed at eliminating these disparities.

No relevant disclosures.

Referenve

Rideout N. OHSU research finds persistent racial disparities in cesarean births. OSHU. November 17, 2025. Accessed November 25, 2025. https://news.ohsu.edu/2025/11/17/ohsu-research-finds-persistent-racial-disparities-in-cesarean-births.