Associations of spatial accessibility to maternity care services and adverse pregnancy outcomes

The decline of accessible maternity care services is a growing concern in the United States (U.S.). Currently, over 2 million reproductive-aged women live in U.S. counties without any hospitals providing obstetric care, birth centers, or obstetric care providers.1 We used a geocoded, population-based cohort of Pennsylvania birth records from 2011-2015 to study whether spatial accessibility to maternity care services was associated with adverse pregnancy outcomes. We explored (i) accessibility to obstetricians and prenatal care utilization adequacy; (ii) distance to delivery hospital and adverse pregnancy outcomes; and finally, (iii) accessibility and availability to hospital-based obstetric care and adverse pregnancy outcomes. Our results provide evidence of a direct association between spatial accessibility to maternity care services and adverse pregnancy outcomes. We found that regardless of rurality, a higher number of obstetricians per 1,000 mothers in a 15 km radius of residence was associated with more cases of adequate prenatal care utilization. For every 100 women, urban women with ≥30 obstetricians had 7.0 (95% CI: 6.3–7.8) more cases of adequate prenatal care and rural women had 2.4 (95% CI: 0.2–4.7) more cases compared to the reference category of