The Impact of Healthcare Deserts on Obstetric Outcomes Among U.S. Military Service Members

Areas without adequate access for obstetric health care known as maternal health care deserts (MHCD) make up a large part of the United States and significantly impact access to care. Increasing attention has been drawn to stationing of active duty service members (ADSM) and their families in these areas with little to no obstetric health care. This study aims to assess the association between U.S. military base location and ADSM obstetric outcomes.

This is an observational, retrospective cohort study using de-identified data sourced from the Medical Assessment and Readiness System. The Medical Assessment and Readiness System protocol was approved by the Naval Medical Center Portsmouth Institutional Review Board. Using this repository, researchers identified all pregnant ADSMs between 2011 and 2021 with and without preventable pregnancy outcomes (PPO). Demographic, military, and health factor data were compared using t-test and chi-squared test. A survival analysis was used to assess the effects of social and community factors associated with maternal health care deserts on PPO risk.

Between 2011 and 2021, 545,851 female ADSM began military service and had 141,360 incident pregnancies. There were 21,544 pregnancies that resulted in PPO, or 152.4 PPO per 1,000 pregnancies. Factors associated with increased PPO risk include younger age, higher body mass index, Asian/Pacific Islander race, lower rank, non-Air Force service, non-married status, income level, proximity to obstetric care and increasing Social Deprivation Index. PPO risk increased when both the obstetric clinic and the patient residence were in an area with increased Social Deprivation index (adjusted hazard ratio = 5.07; 95% CI, 4.86-5.28). Risk of PPO increased with increasing distance between the obstetric clinic and patient residence.

This study demonstrates that the risk of adverse pregnancy outcomes was higher among those living or being treated in high socioeconomic deprivation areas as well as those living further away from their treating clinic. Further studies should be undertaken to investigate the effects of obstetric healthcare deserts on obstetric outcomes in female servicemembers.