In the United States (US), Black women are disproportionately impacted by maternal health inequities including an increased risk of mortality and morbidity. More specifically, Black women are more likely to undergo a cesarean birth, even when non-medically indicated, in comparison to other racial and ethnic groups. The increased risk of this surgical procedure among Black women warrants additional study as the efforts to explain the racial disparity have fallen short. Previous research has identified maternal health behaviors, co-morbidities, socioeconomic status, and access to quality care as factors associated with increased risk of cesarean birth among Black women. However, the identified factors do not fully account for the variation in cesarean births. The purpose of the dissertation is to explore the social and structural factors that influence cesarean rates among Black women in the US to support the development of future interventions.The first manuscript provided a scoping review of peer reviewed research on the risk and protective factors associated with cesarean birth among Black women in the US. Data were synthesized according to the Arksey and O’Malley Scoping Review Framework. The review provided a summary of these factors as well as notable gaps identified in the literature. There were thirteen risk and protective factors from the individual, community, and organizational levels associated with cesarean birth among Black women. The review highlighted the need to acknowledge conceptual considerations, methodological issues, and to include an anti-racist lens in the development of future research studies. The second manuscript examined the association between experiencing racial discrimination and delivery method using data from the 2016-2021 Pregnancy Risk Monitoring System (PRAMS). The analytic sample comprised nulliparous and primiparous women of reproductive age. Logistic regression was used to model the association between experiencing racial discrimination and delivery method. Racial discrimination was significantly associated with primary cesarean birth; however, after adjustment for confounders was no longer statistically significant. These findings will inform future research efforts that need to expand racial discrimination measures in population-based datasets. The third manuscript incorporated a phenomenological approach to understand the experiences, perceptions, and needs of Black women following a cesarean birth. Ten semi-structured interviews were conducted with Black women who had a cesarean birth in the last five years. Seven themes emerged from the interviews. Black women shared experiences from pregnancy through to postpartum, highlighting various avenues for improvement in maternity care. This dissertation makes significant contributions to the understanding of racial disparities in cesarean births and provides insight into next steps for continued study. The results can be leveraged to health professionals to inform evidence-based practice and research, as well as influence the development of clinical policies to safely reduce cesarean births among Black women. This work supports the premise that all women should receive optimal maternity care and Black women are no exception.