Picture two pregnant people walking into the same hospital to give birth.

They have identical medical histories and experienced identical pregnancies. They’re seeing the same obstetrician.

The only difference between them is that one is Black and the other is white.

According to a study of births in New Jersey hospitals, the Black patient would be about 20 percent more likely to get an unscheduled C-section than the white patient.

That number takes into account factors like differences in health status or access to good hospitals and doctors.

Without controlling for those variables, the number is even higher, with researchers finding that Black pregnant people are almost 25 percent more likely to get an unscheduled C-section than their white peers.

C-sections can, of course, save lives.

But they also carry all the risks of a serious surgery, so the idea that people might be pressured into having C-sections unnecessarily is troubling enough.

The fact that this seems to happen disproportionately to Black people is even more disturbing.

Joining us today is Adriana Corredor-Waldron, an assistant professor of economics at NC State University and one of the authors of the working paper I mentioned.

Thanks so much for taking the time to talk with us today.

Thank you for having me.

So I’m curious: You know, as somebody focusing on economics, what prompted you to study C-sections?

In my research in general I am interested in understanding how public policy changes or shape health care provision and also provider behavior.

But specifically to this paper, what we wanted to understand is why Black infants are more likely to be deliver by C-section than white infants—and this is a pattern that you see across the United States.

We have data on New Jersey, so the first thing that we checked is if we can replicate this part—this pattern in New Jersey.

And what we find is that, as well as the aggregates in the U.S., but also previous studies that had suggested in different health care systems, we can see the same pattern emerging for this state.

Mm, and why is an increase in C-sections troubling from, you know, a maternal and fetal health perspective?

I want to clarify that this paper’s—what we want to talk about: it’s low-risk mothers getting an unscheduled C-section ... Right.

C-sections among high-risk mothers can save the life of the baby and the life of the mother.

Absolutely, yeah.

But when we talked about C-sections among low-risk mothers, we are basically saying that mothers are receiving a surgical procedure that carries a higher risk for complications, but also in the case of C-section, that is something that is gonna put the mother in a completely different track for future pregnancies.

So we are taking low-risk mothers and then performing these discretionary C-section, and then from the next birth on they will very likely need another surgical procedure, or another C-section.

And did you uncover anything that helped explain what’s driving these disparities?

What we have is very rich data from New Jersey from 2008 to 2017.

And we are able to rule out what people might think is driving this racial disparity: we’re able to rule out, one by one, medical risk factors from the birth certificates that include eclampsia, previous C-section, if it—there is a breech presentation, and we fit all this data from (more than) 900,000 birth to a machine-learning algorithm.