Are emergency C-sections more likely among certain ethnic groups?

C-sections are a common intervention in maternity care, often used when complications arise that put the life or health of the baby or mother at risk. While elective C-sections are planned to reduce labour risks, emergency C-sections often occur when a vaginal delivery is intended but something has gone wrong.

Higher rates of emergency C-sections can signal systemic issues, especially when those rates differ sharply across groups. Differences can highlight disparities in access to quality antenatal care, the presence of underlying health conditions, or even the role of systemic bias within health services.

The chart below explores the intersection of ethnicity and socio-economic deprivation in shaping the likelihood of emergency C-sections in England. Using deprivation quintiles (where quintile 1 is the least deprived and quintile 5 is the most deprived), it compares the percentage of emergency C-sections across five broad ethnic groups: Asian, Black, Mixed, Other, and White. 

The chart reveals some concerning trends. Firstly, women and people giving birth from minority ethnic groups, especially Black and Asian, see higher rates of emergency C-sections than the White group. Women and people giving birth from Black ethnic backgrounds have the highest rates of emergency C-sections, regardless of deprivation quintile. This is not a marginal difference – even Black women and people giving birth in the least socio-economically deprived group have higher rates than the most deprived in every other ethnic group. This suggests that deprivation alone cannot explain the ethnic disparities.

This pattern is both concerning and difficult to fully explain. One reason for this could be that Black and Asian women and people giving birth are more likely to develop pre-eclampsia, but even if this is the case, why aren’t warning signs being noticed earlier? Appropriate monitoring of the health of mother and baby throughout the pregnancy should decrease the necessity of an unplanned C-section.

Previous research has highlighted how women and people giving birth from minority backgrounds often report feeling dismissed, which may contribute to delays in diagnosis or appropriate escalation – resulting in a higher likelihood of emergency intervention.

Systemic racism may also help explain why women and people giving birth from minoritised ethnicities have higher rates of emergency C-sections, but limitations in the data mean we must caveat our assessment. The dataset did not provide detail on why the C-section was performed, which could include a wide variety of clinical reasons that typically affect certain groups more than others. The data also does not account for health status or parity (first versus subsequent birth), all of which could be confounding factors. But even allowing for those unknowns, the stark differences across groups require further investigation.

Ultimately, this data adds to a growing body of evidence that maternal health outcomes in the UK are not equal. The consistent pattern of higher emergency C-section rates among Black and Asian women and people giving birth – even among the least deprived – raises urgent questions about equity, quality of care, and trust in the system. This matters not only for fairness but for safety. Maternity outcomes are a powerful indicator of how well a health system serves its population. If we are to improve outcomes for all mothers, the next steps must involve targeted research, listening to lived experience, and building systems that deliver truly equitable care.