Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana

Abstract

Background: Maternal mortality is an issue of growing concern in the United States, where the incidence of death during pregnancy and postpartum seems to be increasing. The purpose of this analysis was to explore whether residing in a maternity care desert (defined as a county with no hospital offering obstetric care and no OB/GYN or certified nurse midwife providers) was associated with risk of death during pregnancy and up to 1 year postpartum among women in Louisiana from 2016 to 2017.

Methods: Data provided by the March of Dimes were used to classify Louisiana parishes by level of access to maternity care. Using data on all pregnancy-associated deaths verified by the Louisiana Department of Health (n = 112 from 2016 to 2017) and geocoded live births occurring in Louisiana during the same time period (n = 101,484), we fit adjusted modified Poisson regression models with generalized estimating equations and exploratory spatial analysis to identify significant associations between place of residence and risk of death.

Results: We found that the risk of death during pregnancy and up to 1 year postpartum owing to any cause (pregnancy-associated mortality) and in particular death owing to obstetric causes (pregnancy-related mortality) was significantly elevated among women residing in maternity care deserts compared with women in areas with greater access (adjusted risk ratio [aRR] for pregnancy-associated mortality, 1.91; 95% confidence interval [CI], 1.15-3.18; aRR for pregnancy-related mortality, 3.37; 95% CI, 1.71-6.65). A large racial inequity in risk persisted above and beyond differences in geographic access to maternity care (non-Hispanic Black vs. non-Hispanic White aRR for pregnancy-associated mortality, 2.22; 95% CI, 1.39-3.56; aRR for pregnancy-related mortality, 2.66; 95% CI, 1.16-6.12).

Conclusions: Ensuring access to maternity care may be an important step toward maternal mortality prevention, but may alone be insufficient for achieving maternal health equity.

Figure 1.

Maternity Care Access by Louisiana Parish and Local Moran’s I (LISA) Test for Spatial Autocorrelation of Maternity Care Deserts, 2016–2017. A.) Level of maternity care access by Louisiana parish, 2016–2017. B.) Local Moran’s I (LISA) test for spatial autocorrelation of maternity care deserts, Louisiana 2016–2017. ^aHigh-high indicates parishes with limited or no access to maternity care surrounded by other parishes with limited or no access to maternity care. ^bHigh-low indicates parishes with limit or no access to maternity care surrounded by parishes with access to maternity care.