Differences in Determinants: Racialized Obstetric Care and Increases in U.S. State Labor Induction Rates

J Health Soc Behav. 2023 Jun;64(2):174-191. doi: 10.1177/00221465231165284. Epub 2023 Apr 26.


Induction of labor (IOL) rates in the United States have nearly tripled since 1990. We examine official U.S. birth records to document increases in states' IOL rates among pregnancies to Black, Latina, and White women. We test if the increases are associated with changes in demographic characteristics and risk factors among states' racial-ethnic childbearing populations. Among pregnancies to White women, increases in state IOL rates are strongly associated with changes in risk factors among White childbearing populations. However, the rising IOL rates among pregnancies to Black and Latina women are not due to changing factors in their own populations but are instead driven by changing factors among states' White childbearing populations. The results suggest systemic racism may be shaping U.S. obstetric care whereby care is not "centered at the margins" but is instead responsive to characteristics in states' White populations.

Keywords: health care inequities; induction of labor; natality data; obstetric practices; structural racism.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Black or African American
  • Female
  • Healthcare Disparities*
  • Hispanic or Latino
  • Humans
  • Labor, Induced*
  • Pregnancy
  • Racism
  • Risk Factors
  • United States
  • White