The Association Between Experiencing Racial Discrimination and Delivery Method Among Women in the United States,...

Racial and ethnic disparities in cesarean birth persist, resulting in increased risk of complications. However, the efforts to explain these phenomena have not considered the influence of structural factors. The purpose of this study was to examine the association between experiencing racial discrimination and delivery method, as well as to observe women's experiences with racial discrimination.

Data from the 2016-2021 Pregnancy Risk Assessment Monitoring System was used for this secondary data analysis of nulliparous and primiparous women of reproductive age (N = 27, 994). The exposure variable was measured using two questions on racial discrimination, and information on the outcome variable was obtained from the birth certificate data. Logistic regression was used to model the association between experiencing racial discrimination and delivery method.

Within the population, minority women (non-Hispanic Black, Hispanic, and non-Hispanic Other women) experienced significantly increased odds of experiencing racial discrimination in comparison to non-Hispanic White women. Racial discrimination was significantly associated with primary cesarean birth in the bivariate analysis (OR, 1.19; 95% CI, 1,03-1.38); however, this relationship became marginally significant after adjustment for confounders (OR, 1.09; 95% CI, 0.94-1.28).

Although the association between racial discrimination and delivery method was not statistically significant, even after stratification by race/ethnicity, future research should focus on expanding current measures of racial discrimination in population-based datasets. There is a missed opportunity to understand and explore the experiences of racial discrimination and delivery method, especially during labor/delivery. A comprehensive view of the mechanisms by which racial disparities in cesarean birth continue to operate is critical to reducing health inequities.