The United States (U.S.) has one of the highest cesarean rates in the world yet little research considers structural factors, like racism and sexism, associated with the higher than recommended cesarean rate. New research operationalizes and quantifies structural sexism across U.S. states, which allows for consideration of how social norms and values around women and their bodies relate to the overmedicalization of birth through cesarean sections. We obtained restricted natality data for 2018 from the U.S. National Center for Health Statistics. In 2018, among people 15–49 years, 987,187 births fit the criteria for low-risk of cesarean section. Structural sexism scores were derived from 6 elements covering economic, political, cultural, and physical arenas that were totaled and standardized to create an aggregate index for each state and DC (scores range from −1.06 to 1.4). Using multivariable logistic and multilevel mixed effects logistic regression models, we examined the associations between structural sexism and low-risk cesarean section for all fifty states and the District of Columbia, controlling for relevant confounders. We found that structural sexism in 2018 was highest in historically religious mountain states and the South. Nationally, the low-risk cesarean rate was 25.1%. Multilevel models show that people living in states with higher structural sexism scores were more likely to have a cesarean section (OR = 1.22, 95% CI: 1.07–1.39). Structural sexism is related to low-risk cesarean rates in U.S., providing evidence that social ideas and norms about women and their bodies are related to overmedicalization of birth. Health policymakers, providers and scholars should pay attention to structural drivers, including structural sexism, as a factor that affects overmedicalization of birth and subsequent health outcomes for pregnant people and their infants.

美国是世界上剖腹产率最高的国家之一，但很少有研究考虑结构性因素，如种族主义和性别歧视，与高于建议的剖腹产率相关。新的研究对美国各州的结构性性别歧视进行了操作和量化，从而可以考虑围绕妇女及其身体的社会规范和价值观与剖腹产分娩的过度医疗化之间的关系。我们从美国国家卫生统计中心获得了 2018 年限制出生数据。2018年，在15-49岁人群中，有987,187名新生儿符合剖宫产低风险标准。结 使用多变量逻辑和多级混合效应逻辑回归模型，我们检查了所有五十个州和哥伦比亚特区的结构性性别歧视与低风险剖宫产之间的关联，并控制了相关混杂因素。我们发现，2018 年结构性性别歧视在历史上有宗教信仰的山区国家和南方最为严重。全国低风险剖宫产率为25.1%。多层次模型显示，生活在结构性性别歧视得分较高的州的人们更有可能进行剖腹产（OR = 1.22，95% CI：1.07–1.39）。结构性性别歧视与美国的低风险剖腹产率有关，这提供了证据表明有关妇女及其身体的社会观念和规范与分娩的过度医疗化有关。卫生政策制定者、提供者和学者应关注结构性驱动因素，包括结构性性别歧视，这是影响分娩过度医疗以及孕妇及其婴儿随后健康结果的一个因素。