Deserts of disparity: Social vulnerability's role in maternity care gaps

To determine the relationship between maternity care deserts and social vulnerability.

1084 counties from the March of Dimes (2019-2021) and the CDC/ATSDR Social Vulnerability Index (SVI, 2020) across 11 U.S. states were assessed. Linear regression models analyzed the relationships between social vulnerability, obstetric providers, and uninsured women.

SVI did not bear any statistical influence on maternity care desert classifications (r = -0.050, p = 0.101). However, higher SVI was correlated with fewer obstetric providers (β = -0.524, p < 0.001) and higher uninsured rates (β = 0.151, p < 0.001). Socioeconomic vulnerability (r = -0.143, p < 0.001) and household characteristics (r = -0.146, p < 0.001) were associated with reduced maternity care access, while racial and ethnic minority status (r = 0.064, p = 0.036) and housing type and transportation (r = 0.165, p < 0.001) were associated with greater access.

Counties with greater vulnerability in socioeconomic status and household characteristics tended to have fewer obstetric providers available and higher proportions of uninsured women, indicating a double burden of social risk and limited medical infrastructure. Counties with greater vulnerability in racial and ethnic minority status and housing type and transportation were paradoxically associated with greater availability of maternity care resources, suggesting that despite diverse communities experiencing poor outcomes, they have the medical means available.

Our findings suggest that barriers to maternity care extend beyond resource availability, requiring efforts that address systemic barriers and equitable resource allocation.