Pain is not believed equally

In the study that asked 110 women directly whether they felt pain during their cesarean, 36% said yes. Being Black was one of the factors independently associated with reporting pain, alongside longer surgery, a history of anxiety, and having a labor epidural topped up rather than a fresh spinal.

After the operation the pattern continues. In 9,900 women, Black women had 2.18 times the adjusted odds of reporting pain of 5 or more out of 10, and Hispanic women 1.61 times the odds, compared with white women. Both groups received fewer morphine equivalents per day and were less likely to be given a prescription at discharge. A separate study of 1,701 women after cesarean found that white women had their pain formally assessed more often in the first 24 hours (an average of 10.2 assessments against 8.4 to 9.5 for other groups). A 2025 systematic review of 8 studies and 22,259 patients found the same pattern repeatedly: higher reported pain, less medication.

One reason has been studied directly. In a sample of white medical students and residents, half endorsed at least one false belief about biological differences between Black and white people, such as thicker skin. Those who endorsed such beliefs rated a Black patient's pain lower and made less accurate treatment recommendations. Those who did not showed no such gap.