Study finds social inequity reduces neuraxial analgesia use in labor


A recent study highlighted how racial disparities, exacerbated by structural racism, impact the administration of neuraxial analgesia during labor, underscoring the need for interventions to address social inequity in maternal health care access.

Study finds social inequity reduces neuraxial analgesia use in labor | Image Credit: © Inez - © Inez -

Study finds social inequity reduces neuraxial analgesia use in labor | Image Credit: © Inez - © Inez -

Neuraxial analgesia use is reduced by social inequity among US women, according to a recent study published in Obstetrics & Gynecology.1


  1. Racial disparities persist in the administration of neuraxial analgesia during labor, with Black women being less likely to receive this effective pain relief compared to White women.
  2. Structural racism, including factors such as unemployment, incarceration rates, and education levels, contributes significantly to these disparities.
  3. Black women giving birth in counties with high social inequity experience even lower rates of neuraxial analgesia use, highlighting the compounding effects of systemic inequities.
  4. Interventions aimed at addressing socioeconomic disparities could help reduce the gap in access to effective pain management during labor.
  5. These findings underscore the urgent need for policies and initiatives that tackle structural racism and promote equitable access to maternal healthcare services.

Neuraxial analgesia is a combination spinal and epidural pain reliever and is the most effective analgesia for use during labor, leading to reduced pain and maternal morbidity. It is administered to approximately ¾ of women in labor in the United States.

The odds of receiving neuraxial analgesia are reduced by approximately 10% among Black women compared to White Women. Patient preferences because of a lack of prenatal education and reduced access because of a lack of a 24/7 dedicated obstetric anesthesia team have been linked to this disparity.

“Social inequity and racism could be significant contributors to racial and ethnic disparities in labor neuraxial analgesia use,” said Jean Guglielminotti, MD, PhD, assistant professor of anesthesiology at Columbia P&S, and first author. “Racism - including structural, institutional, and interpersonal racism- is suggested as a root cause of racial and ethnic disparities in perinatal care access and utilization in the United States.”

Investigators conducted a cross-sectional study to evaluate the association between structural racism and neuraxial analgesia use during labor.2 US natality data from 2017 was used to compare results between non-Hispanic Black and non-Hispanic White patients.

Structural racism was determined using a multidimensional index within the county of birth, measured as the mean of 3 inequity ratios. These included unemployment, incarceration in jails, and lower education ratios.

There were 1,740,716 births included in the analysis, 22.8% of which were for Black people. In the first tercile of the racism index, neuraxial analgesia during labor had a reported rate of 77.2% for Black patients, the second tercile 74.7%, and the third tercile 72.4%. These rates were 80.4%, 78.2%, and 78.2%, respectively, among White patients.

The odds of receiving neuraxial analgesia were reduced by 18.4% in the second tercile compared to the first among Black patients, and by 28.3% in the third tercile. These reductions were 13.4% and 15.6%, respectively, for White patients.

Overall, the odds of receiving neuraxial analgesia during labor were reduced by 17% among Black women vs White women and giving birth in a county with high social inequity decreased use by 16% among Black women and 28% among Black women.1 These results indicate interventions to improve socioeconomic equity may reduce these disparities.


  1. Social inequity is linked to lower use of epidural in childbirth. EurekAlert. February 1, 2024. Accessed February 6, 2024.
  2. Guglielminotti J, Lee A, Landau R, Samari G, Li G. Structural racism and use of labor neuraxial analgesia among non-hispanic black birthing people. Obstetrics & Gynecology. 2024. doi:10.1097/AOG.0000000000005519
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