A scoping review of risk and protective factors associated with cesarean birth among Black women in the United States

Cesarean birth is the most performed surgical procedure in the United States (U.S.), impacting 1.3 million women yearly. This procedure is associated with adverse health complications and increased costs. Although Black women are the most likely to experience cesarean birth, there is a paucity of research explaining why this disparity exists. We conducted a scoping review informed by the Public Health Critical Race praxis to identify and synthesize research on the factors associated with cesarean birth among Black women in the U.S. PubMed, Web of Science, and CINAHL were searched for studies that evaluated risk and protective factors for cesarean birth among Black women. Thirty-four articles met inclusion criteria. Individual, community, and organizational-level factors were associated with cesarean births among Black women. The observed factors were sub-classified as clinical or non-clinical. Gaps in the literature included lack of information on intrapersonal and structural factors and a scarcity of studies informed by an anti-racist praxis. Research should operationalize race and identify racial disparities in cesarean birth as a quality improvement metric in obstetric care. This review highlights existing evidence on racial disparities in cesarean birth, identifies multi-level determinants, and encourages the development of culturally responsive interventions to promote maternal health equity.