Racial cuts: Explanations of race inequities in cesarean births in U.S. government and medical discourse

and attracting public health initiatives to reduce cesarean rates. The U.S. cesarean epidemic is racialized, consisting of cesarean overuse in low-risk contexts and underuse in high-risk contexts for Black birthing people. Research shows health initiatives portray Black women as non-compliant with health directives, justifying inequitable outcomes in reproductive contexts, including birth, breastfeeding, and pre-pregnancy health. However, research has not examined initiatives to reduce cesareans, which are distinct because they occur within hospitals and are authorized by medical professionals. This study used critical discourse analysis to investigate constructions of race inequities in cesareans across 59 documents published between 2010 and 2025 by U.S. government agencies and medical organizations. Findings revealed cesareans are constructed as lifesaving procedures that carry inherent risks of detrimental outcomes, including death. Documents acknowledged race inequities in cesareans, but associated them with comorbidities (e.g. hypertension) rather than structural or obstetric racism; explaining and eradicating race inequities was rarely addressed. By centering behavioral and biomedical risk factors, discourses reproduce Black birthing people as inherently "high-risk," thereby legitimizing cesarean overuse. Centering cesareans as a discursive site of racialization, this study shows how surgical intervention is justified through language that marks Black bodies as pathologically susceptible to "risk." These findings illustrate that cesarean birth functions not only as a medical intervention but also as a site of racialized reproductive governance.