Addressing Racial Disparities in Cesarean Delivery Rates Using A Digital Program: Preliminary Findings [A271

Abstract

INTRODUCTION: Current U.S. data indicate racial disparities in cesarean delivery rates, with Black mothers most likely to deliver via cesarean. We examined the association between use of a digital health program with virtual education appointments and cesarean delivery rates, overall and by race and ethnicity. METHODS: Participants were 524 women with singleton pregnancies who enrolled in a digital health program in 2020 and completed self-report questionnaires on race/ethnicity, medical history, and pregnancy outcomes. We used logistic regression to test associations between program engagement (operationalized as total virtual appointments) and cesarean delivery, controlling for age, trimester at program enrollment, and history of cesarean delivery. RESULTS: Overall, 29% delivered via cesarean section in their current pregnancy; 12% reported cesarean delivery in a past pregnancy. History of cesarean delivery was higher among Black mothers (29%). In the full sample, appointments and type of delivery were unrelated. When inspecting this association separately for different racial and ethnic groups of sufficient sample size (Asian, Black, Hispanic, Multiracial, White), a significant, inverse relationship between appointments and likelihood of cesarean delivery was observed specifically among Black mothers (P=.043). Providers most popularly sought by Black mothers included doulas (27%) and obstetricians (21%), and Black mothers had higher rates of birth-planning appointments (14%) than other groups. CONCLUSION: These preliminary data suggest that access to virtual appointments may help reduce racial disparities in cesarean delivery rates. Research is needed to clarify the mechanisms by which digital health engagement addresses these disparities.