Racial Cuts: Explanations of Race Inequities in Cesarean Births in U.S. Government and Medical Discourses

• In Event: Medical Sociology Section Roundtables
  In Refereed Roundtable (90 minute): Table 9. Racialized Experiences of Health and Healthcare

Abstract

Black maternity care patients experience higher cesarean rates than other racial/ethnic groups, yet research has not examined how institutional discourses construct these inequities. Research shows maternal health initiatives in contexts of pregnancy health and breastfeeding portray Black women as responsible for adverse outcomes, thereby requiring surveillance and intervention. Cesarean discourse is distinct because the procedure occurs within hospitals and is authorized by medical professionals. This study used critical discourse analysis (CDA) to investigate representations of race inequities in cesareans in 60 documents published by U.S. government agencies and major medical organizations between 2010 and 2025. Findings revealed paradoxical constructions of cesareans, described as lifesaving yet risky, and medically necessary yet overused and costly. Documents acknowledged race differences in cesareans, yet associated inequities with comorbidities such as hypertension, obesity, diabetes, and maternal age, while structural racism and institutional decision-making were mentioned but largely unaddressed. Black maternal subjects were constructed as a population defined by adverse outcomes and heightened vulnerability to severe maternal and infant morbidity and mortality. By centering behavioral and biomedical risk factors rather than racism, these discourses reproduce Black maternal subjects as inherently “high-risk,” thereby legitimizing the overuse of cesarean. Centering cesareans as a discursive site of racialization, this study shows how surgical intervention becomes routinized and justified through language that marks Black bodies as pathologically susceptible to “risk.” We argue that cesarean birth functions not only as a medical intervention but also as a site of racialized governance that requires moving beyond rate reduction toward confronting structural racism within obstetric care.

Authors

• Shannon K. Carter, University of Central Florida

• Jonzelle Bell, University of Central Florida

• Sara Tehrani, University of Central Florida