State-Level Prevalence of Maternity Care Deserts: Association With Healthcare Access, Utilization, and Outcomes Among...

More than 2 million women of childbearing age live in U.S. counties without access to maternity care-counties referred to as maternity care deserts. The objective of this study was to identify whether living in a state with a high prevalence of maternity care deserts is associated with maternal and child health access and utilization and contributing to adverse health outcomes among Medicaid recipients.

This is a descriptive, cross-sectional, secondary data analysis using most recent data available (2021-2023) from multiple existing state-level sources (e.g., Medicaid Health Care Core Data Sets, March of Dimes Peristats, Pregnancy Risk Assessment Monitoring System). State-level analyses included all U.S. states, District of Columbia, and Puerto Rico (N=52). Analyses were stratified by state prevalence of maternity care deserts (high=states where ≥21% of counties have no hospital/birth center providing obstetric services). Multivariate analyses of covariance were used to test associations with 3 domains of dependent variables: healthcare access (i.e., mental health, pediatrics, family medicine), utilization (e.g., timely access to pre and postnatal care, vaccinations), and maternal/child health outcomes (e.g., maternal and infant mortality).

Three multivariate analysis of covariance tests indicated significant main effects for state-level maternity care desert prevalence and all domains (all p<0.009), with large effect sizes (η2≥0.14). Effects were durable, even after controlling for state-level covariates. States/territories with high prevalence of maternity care deserts had more rural counties (t= -4.22, p<0.001), lower levels of educational attainment (t= -2.32, p=0.024), and lower median household income (t=3.09, p=0.004). Those living in states/territories with high prevalence of maternity care deserts had 30% fewer mental healthcare providers (487.50 vs 696.50/100,000 population) and 36% fewer pediatricians (14.25 vs 22.31/100,000 population). They were ∼14% less likely to receive timely prenatal and postpartum care. Infants were 28.62% less likely to receive influenza vaccinations before second birthday. Critically, those in states/territories with high prevalence of maternity care deserts had 34.20% greater risk of maternal mortality, 18.34% greater risk of infant mortality, and 8.92% greater risk of low birthweight.

High state-level prevalence of maternity care deserts is associated with adverse maternal and child outcomes; exacerbating concerns as health during the perinatal period sets the trajectory for health across the lifespan. Policy and practice solutions must address pervasive health inequities associated with maternity care deserts (e.g., expanding access to maternity care through family medicine physicians, doulas, telehealth access, and supporting rural obstetric readiness).