ORCID

0000-0003-3334-1437 (Robbins)

Document Type

Article

Publication Date

2025

DOI

10.1097/aog.0000000000005976

Publication Title

Obstetrics and Gynecology

Volume

146

Issue

2

Pages

181-188

Abstract

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.

Rights

Copyright © 2025 The Authors.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0).

Original Publication Citation

Atwani, R., Robbins, L., Saade, G., & Kawakita, T. (2025). Association of maternity care deserts with maternal and pregnancy-related mortality. Obstetrics and Gynecology, 146(2), 181-188. https://doi.org/10.1097/aog.0000000000005976

Additional Files
aog_146_2_2025_06_03_atwani_25-382_sdc1.pdf (1517 kB)
Appendix 1-7
aog_146_2_2025_06_03_tpratwani_25-382_sdc2.pdf (475 kB)
Peer Review Correspondence
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