Date of Award

January 2024

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Jeannette Ickovics

Abstract

Objective: The primary objective of this study is to evaluate whether state-level prevalence of maternity care deserts influence maternal and child health access, utilization, and outcomes in the United States. The goal is to identify the state-level gaps in access to and utilization of healthcare services that contribute to pervasive inequities in maternal and infant mortality and other adverse health outcomes among Medicaid recipients in the United States.Methods: Performed a cross-sectional, secondary data analysis, using state-level data from existing data sources to achieve the research aims (maternal and child health access, utilization, and outcomes). All of the states within the United States, as well as Puerto Rico and the District of Columbia were included in these state-level analyses (n= 52). Analyses were conducted based on stratification by state prevalence of maternity care access to determine the effects of maternity care access by state. SAS Version 9.4 was used for the statistical analyses, including one-tailed t-tests to perform bivariate analyses and three multivariate analysis of covariance (MANCOVA) tests to evaluate the association between maternity care desert prevalence and the access, utilization, and maternal and child health outcomes variables. ArcGIS Online was used to develop maps representing access to healthcare services (i.e. maternity, mental health, pediatric, and family medicine) in the United States. Results: The results indicate that there are numerous differences between states with a high versus low prevalence of maternity care deserts. The three MANCOVA tests indicate overall significant main effects between state-level maternity care desert prevalence and maternal and child health access (p< 0.001), utilization (p= 0.009), and outcomes (p< 0.001), with large effect sizes (η2 ≥ 0.14). In particular, the results reveal that there is a statistically significant association between state prevalence of maternity care deserts and access to mental healthcare and pediatric healthcare, timeliness of prenatal and postpartum care, maternal and infant mortality rates, percentage of children receiving flu vaccinations, and infant low birthweight. Among the most concerning results is that states with a higher prevalence of maternity care deserts also have significantly higher rates of maternal and infant mortality, in which a high prevalence of maternity care deserts is associated with a 22% increased likelihood of infant mortality. Conclusions: This study provides a comprehensive understanding of the impact of living in a state with a high prevalence of maternity care deserts with a focus on maternal and child health access, utilization, and outcomes. The study findings provide significant public health and state-level policy implications towards addressing patterns of healthcare shortages that are vital to support perinatal health and address the maternal and child health crisis in the United States. For example, feasible solutions to address concerns related to maternity care deserts include: expanding access to maternity care through the use of family medicine providers, Federally Qualified Health Centers, and doulas; supporting rural obstetric readiness within hospitals; extending pregnancy-related insurance coverage; and the development of maternal mortality review committees and State Perinatal Quality Collaboratives.

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This is an Open Access Thesis.

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