Evaluating Racial and Ethnic Differences in Use of Elective Labor Induction for Low-Risk Births A Retrospective Cohort Study

Purpose: The study sought to identify differences in use of elective induction of labor (IOL) post-ARRIVE trial, by race and ethnicity, and contributions of multilevel contextual factors to induction use. Background: Racial disparities in birth outcomes have been attributed to community and provider (ie, multilevel contextual) factors. The varied use of elective induction, a common obstetric procedure, can provide insights on how racial biases are evidenced in care delivery. Methods: A retrospective cohort study, 2018 from 2020, utilized health record data from a multi-hospital regional health system to identify the sample of term, singleton gestations without maternal or fetal indications for induction. Multivariate logistic regression was used to test associations between race/ethnicity and odds of labor induction. Results: Labor induction occurred in 26.8% of 10 473 births. Use varied by reported race or ethnicity; non-Hispanic-White (31.1%), -Asian (22.2%), -Black or African American (22.1%), and -all other races (24.1%) and Hispanic (19.3%). Hispanic women had significantly fewer labor inductions compared to non-Hispanic White women (odds ratio [OR]: 0.62, 95% confidence interval [CI]: 0.55-0.70, P < .001). Physician care was associated with higher use compared to midwifery care (OR: 1.48, 95% CI: 1.33-1.65, P < .001); hospital geographic location and older maternal age were associated with higher induction use. Hispanic women had significantly higher rate of cesarean birth after IOL. Conclusions: Provider type, hospital geographic location, and maternal age predicted differences in elective IOL use between racial and ethnic groups. Implications for practice and research: Future research should focus on additional contextual factors affecting use of elective induction and resultant mode of birth, particularly between racial and ethnic groups.