Multi-level Drivers of Disparities in Hispanic Cesarean Delivery Rates in US-Mexico Border States

  • Jill A. McDonaldEmail author
  • Anup Amatya
  • Charlotte C. Gard



Hispanic women living along the US-Mexico border have higher cesarean delivery rates than non-Hispanic white women, African American women, and other Hispanic women in the USA. Their rates also exceed those of other Hispanic women in states that border Mexico and non-Hispanic white women along the border. Our objective was to determine the causes of the disparities in border Hispanic cesarean rates.


Using the 2015 birth certificate file and other sources, we performed a twofold Oaxaca-Blinder decomposition analysis of the disparities in low-risk primary and repeat cesarean rates between Hispanic and non-Hispanic white women in the US-Mexico border counties and Hispanic women residing in nonborder counties of border states.


Rates of low-risk primary cesarean among border Hispanic, nonborder Hispanic, and border non-Hispanic white women were 21.1%, 15.0%, and 16.5%, respectively. Higher Hispanic concentration in county of residence, a larger proportion of for-profit hospital beds, and greater poverty accounted for 24.7%, 22.1%, and 11.1% of the border-nonborder Hispanic difference, respectively. No other variable explained more than 5% of the difference. Higher Hispanic concentration, more for-profit beds, less attendance by an MD, higher BMI, and greater poverty explained 60.6%, 42.4%, 42.4%, 27.4%, and 21.3%, respectively, of the Hispanic-non-Hispanic white difference. Hispanic concentration and for-profit beds were also important explanatory variables for low-risk repeat cesareans.


Efforts to address potentially unnecessary cesareans among Hispanic women on the border should recognize that community demographic and health delivery system characteristics are more influential than maternal medical risk factors.


Cesarean section Health disparities Hispanic Americans Oaxaca-Blinder Poverty 



We gratefully acknowledge the assistance of Mr. Jesus Sigala, MS, in the creation of data files and variables used in the analysis. Mr. Sigala was a graduate student in the Department of Economics, Applied Statistics, and International Business, New Mexico State University, and was compensated through the same grant as the authors.

Funding Information

This project is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under the Maternal and Child Health Field Initiated Research Program, grant no. R40MC30756. HRSA had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

Compliance with Ethical Standards

The Institutional Review Board at the authors’ institution approved this study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

40615_2019_652_MOESM1_ESM.pdf (511 kb)
ESM 1 (PDF 510 kb)


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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of Public Health Sciences, College of Health and Social ServicesNew Mexico State UniversityLas CrucesUSA
  2. 2.Southwest Institute for Health Disparities Research, College of Health and Social ServicesNew Mexico State UniversityLas CrucesUSA
  3. 3.Department of Economics, College ofBusiness, Applied Statistics, and International BusinessNew Mexico State UniversityLas CrucesUSA

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