Predictors of cesarean section delivery among college-educated black and white women, Davidson County, Tennessee, 1990-1994.

Cesarean section delivery increases the cost, morbidity, and mortality of childbirth. Cesarean section rates vary nationwide with the highest rates occurring in the southern United States. The Department of Health and Human Services has published year 2000 objectives that include a 15% reduction in the cesarean section rate. This study identified factors contributing to cesarean section delivery among a cohort of college-educated black and white women in Davidson County, TN. Logistic regression models were applied to Linked Infant Birth and Death certificate data from 1990-1994. Data on singleton first births for 606 black women and 3661 white women completing 16 years of education were analyzed. College-educated African Americans were at a significantly higher risk of cesarean section delivery than whites. This difference could not be accounted for by controlling for all other variables. The geographic differences in cesarean section rates in this country may be the result of varying in provider practice styles, perceptions, or attitudes. Improving the health of women and children will require establishing a system of maternity care that is comprehensive, case-managed, culturally appropriate, and available to all women.