Geographic Gaps in Maternity Care Cost Lives

TOPLINE:

Analysis of 14,772,210 live births revealed that counties designated as maternity care deserts faced significantly higher maternal mortality rates than those with full access to care. Desert counties showed a 36% higher risk for maternal death and a 26% increased risk for pregnancy-related mortality.

METHODOLOGY:

• The analysis included county-level data from the CDC Wide-Ranging Online Data for Epidemiologic Research database from January 2018 to December 2021.
• A total of 14,772,210 live births were analyzed across four county categories: desert (n = 720,858), low access (n = 708,668), moderate access (n = 431,188), and full access (n = 12,911,496).
• Researchers restricted the study population to individuals aged 15-44 years to enhance accuracy and mitigate misclassification.
• Primary outcome measures included maternal mortality rate per 100,000 live births, with pregnancy-related mortality rate as a secondary outcome.

TAKEAWAY:

• Desert counties showed significantly higher maternal mortality rates than full-access counties (32.25 vs 23.62 per 100,000 live births; absolute risk difference, 8.62; 95% CI, 4.63-12.61; adjusted incidence rate ratio [IRR], 1.36; 95% CI, 1.21-1.54).
• Desert counties also demonstrated higher pregnancy-related mortality rates than full-access counties (43.82 vs 34.72 per 100,000 live births; absolute risk difference, 9.10; 95% CI, 4.28-13.93; adjusted IRR, 1.26; 95% CI, 1.13-1.41).
• No significant differences in maternal or pregnancy-related mortality rates were found between low-access or moderate-access counties compared to full-access counties.

IN PRACTICE:

“Maternity care deserts are associated with significantly higher rates of adverse maternal outcomes because limited access to skilled practitioners delays timely interventions during critical stages of pregnancy and childbirth,” the authors of the study wrote.

SOURCE:

This study was led by Tetsuya Kawakita, MD, MS, from the Department of Obstetrics and Gynecology at the Macon and Joan Brock Virginia Health Sciences at Old Dominion University in Norfolk, Virginia. It was published online in Obstetrics & Gynecology.

LIMITATIONS:

Fatalities temporally linked to pregnancy, such as homicide, suicide, or drug overdose, were often coded as external causes on death certificates and may have been excluded from the CDC pregnancy-related mortality classification. The surge in mortality during the COVID pandemic may have accentuated existing disparities. The cross-sectional analysis precluded causal inferences regarding relationships between maternity care access and maternal outcomes. The definition of maternity care practitioners did not include family physicians who might have provided obstetric services in rural areas. Additionally, the maternity care access measure did not capture the intra-county spatial distribution of services, potentially masking access barriers in geographically extensive or sparsely populated rural counties.

DISCLOSURES:

This study received support from the Eastern Virginia Medical School Junior Clinical Investigator Program.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.