Association for Public Policy Analysis & Management

We geographically map the distance between Community Health Centers (CHC) and counties with low access to maternal health services, or “Maternity Care Deserts” (MCDs). The distance serves as an independent variable in our OLS regression analyses to test for an association between a CHC’s proximity to MCDs and maternal health outcomes. Explanatory qualitative interviews will also be conducted with CHC leaders in April 2020.

Results

Overall, we find that as the distance from a CHC to an MCD county decreases, the number of maternal health visits and the number of births at the CHC significantly decrease. We also find several center-level characteristics to be significantly associated with maternal health visits. Specifically, serving a greater number of low-income individuals and a greater number of racial minorities are both associated with significant reductions in maternal health visits, whereas serving a greater number of reproductive-age women is associated with significant increases in maternal health visits. Additionally, we find that CHCs that are located in Medicaid expansion states are associated with significantly more maternal health visits and child births.

Policy Implications

Our findings suggest an inequitable distribution of the maternal health workforce, with CHCs near MCDs experiencing a shortage in supply and perhaps also demand. Additionally, the capacity of CHCs to serve socioeconomically disadvantaged populations can impact their service delivery. Finally, our findings suggest that Medicaid expansions have helped greatly increase service delivery at CHCs that are located closest to MCDs, thereby improving access to care for pregnant women in underserved counties.