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Association of Maternity Care Deserts With Maternal and Pregnancy-Related Mortality
Rula Atwani1, Lindsay Robbins, George Saade
1Department of Obstetrics and Gynecology, Macon and Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia.
Objective:
To evaluate the association between the level of maternity care access and maternal and pregnancy-related mortality.
Methods:
This was a cross-sectional analysis of county-level data in the United States from January 2018 to December 2021. Using the level of maternity care access, we categorized counties into desert, low access, moderate access, and full access. The primary outcome of interest was maternal mortality rate per 100,000 live births. A secondary outcome was pregnancy-related mortality rate per 100,000 live births. Absolute risk differences and adjusted incidence rate ratios were calculated for maternal mortality and pregnancy-related mortality with multivariable negative binomial mixed-effects models.
Results:
The study included 14,772,210 live births across four categories of maternity care access: desert (n=720,858), low access (n=708,668), moderate access (n=431,188), and full access (n=12,911,496). Desert counties compared with full-access counties had a significantly higher maternal mortality rate (32.25 vs 23.62; absolute risk difference 8.62 [95% CI, 4.63-12.61]; adjusted incidence rate ratio 1.36 [95% CI, 1.21-1.54]) and pregnancy-related mortality rate (43.82 vs 34.72; absolute risk difference 9.10 [95% CI, 4.28-13.93]; adjusted incidence rate ratio 1.26 [95% CI, 1.13-1.41]). Low-access counties showed no significant difference in maternal mortality rate (24.04 vs 23.62; absolute risk difference 0.41 [95% CI, -3.68 to 4.51]; adjusted incidence rate ratio 1.02 [95% CI, 0.86-1.21]) or pregnancy-related mortality rate (35.63 vs 34.72; absolute risk difference 0.91 [95% CI, -4.06 to 5.88]; adjusted incidence rate ratio 1.03 [95% CI, 0.89-1.18]). Similarly, moderate-access counties had no significant differences in maternal mortality rate (25.59 vs 23.62; absolute risk difference 1.96 [95% CI, -4.50 to 8.42]; adjusted incidence rate ratio 1.08 [95% CI, 0.84-1.40]) or pregnancy-related mortality rate (37.48 vs 34.72; absolute risk difference 2.76 [95% CI, -5.72 to 11.24]; adjusted incidence rate ratio 1.08 [95% CI, 0.86-1.36]).
Conclusion:
Residing in a maternity care desert is significantly associated with higher rates of maternal and pregnancy-related mortality.
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