# Equity in Obstetrics: Reducing disparities in rates of cesarean birth and cesarean-linked hemorrhages

> **NIH NIH U54** · STANFORD UNIVERSITY · 2024 · $524,262

## Abstract

Project Summary/Abstract: Project 2
Almost 1 in 3 births in the United States involves cesarean delivery. A lifesaving intervention when appropriate,
cesarean is associated with significant risks that include severe postpartum hemorrhage and severe maternal
morbidity (SMM). Compared to vaginal delivery, women undergoing cesarean delivery incur the highest risk of
postpartum hemorrhage and hemorrhage-related morbidity. In the last 30 years, significant disparities in rates
of cesarean birth have developed for Black women, disparities that elevate their risks of morbidity from
hemorrhage and mortality. Reducing cesarean rates is therefore essential for reducing postpartum hemorrhage
and postpartum-related SMM. Eliminating disparities in cesarean delivery requires multifaceted, multilevel
interventions that can be deployed at scale. We will build on our expertise in achieving population-level
improvements in maternal outcomes (including hemorrhage and cesarean delivery) and long-standing
collaborative partnerships with patients, communities, and public health agencies to identify and implement
strategies to reduce disparities in cesarean birth and hemorrhage. Our state-wide quality improvement network
with a sophisticated real-time data center will enable us to support complex equity interventions and track
improvement. Capitalizing on our collaborative network of 218 hospitals covering 99% of births in CA, we will
realize the following Specific Aims: (1) Use mixed method approaches to identify strategies to reduce
disparities in rates of cesarean birth and cesarean-associated hemorrhages. (2) Center patient voices in the
validation and continuous curation of action tools and resources that will be integrated into a Maternal Equity
Guide, a toolkit of resources to drive equity change within hospitals. (3) Expand implementation of the Maternal
Equity Guide in state-wide efforts to reduce disparities. (4) Assess effectiveness of the Maternal Equity Guide
tools/resources and implementation strategies. We collect real-time patient-level data for all California births
including patient-identified race and ethnicity allowing us to measure changes in multiple maternal health
outcomes at state, hospital, and even provider levels. Combined with qualitative methods, this will provide a
particularly robust analysis of effectiveness of our interventions. Results will establish a national roadmap for
effectively integrating equity into large-scale quality improvement to address disparities in rates of cesarean
births with potential application to other aspects of obstetric care.

## Key facts

- **NIH application ID:** 10908644
- **Project number:** 5U54HD113142-02
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** Elliott K Main
- **Activity code:** U54 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $524,262
- **Award type:** 5
- **Project period:** 2023-08-17 → 2030-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10908644

## Citation

> US National Institutes of Health, RePORTER application 10908644, Equity in Obstetrics: Reducing disparities in rates of cesarean birth and cesarean-linked hemorrhages (5U54HD113142-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10908644. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*