Nearly 400,000 Women of Childbearing Age Live in a County With No Maternal Care Professionals

GoodRx Health

This story is part of the GoodRx Research Maternal Care Access series, where we dive into the experiences of mothers and the care they received during pregnancy, labor and birth, and postpartum.

We'll share findings from a survey of 1,015 mothers and combine those insights with additional data to get a clearer picture of the state of U.S. maternal care access.

Our previous Maternal Care Access series story reported that nearly 60% of mothers who recently gave birth were not able to see all the healthcare professionals they wanted to see throughout their pregnancy, labor, and birth.

Access to maternal care access is important because prenatal care promotes the health of the mother and the baby during pregnancy. However, recent trends show that maternal care access is shrinking in the U.S., particularly in rural areas.

To highlight gaps in maternal care, the GoodRx Research team took a closer look at access to care in each U.S. county.

Almost 380 counties have no maternal care professionals

We calculated the number of maternal care professionals per 1,000 births, county by county. We defined maternal care professionals as: (1) OB-GYN, maternal-fetal medicine (MFM), and family practice professionals, which include doctors, physician associates, and nurse practitioners; and (2) midwives.

We found that 376 counties did not have maternal care professionals, and 398,886 women of childbearing age lived in those counties. Despite the lack of access, mothers in those counties gave birth to 25,854 babies from July 2021 to June 2022.

Mothers in those counties who gave birth likely had to travel outside their county to do so - even though distance to the place of birth can be a risk for mothers and their babies.

Below, we show the number of maternal care professionals per 1,000 births in each county.

Women who live in counties colored red on the map do not have access to any maternal care professionals. And women who live in counties colored orange may find it hard to access maternal care: The number of maternal care professionals per 1,000 births in these areas is well below the national rate of 25 professionals per 1,000 births.

Women are even more at risk of poor maternal health outcomes in counties that have both no access to maternal care professionals and are surrounded by other low-access counties. Women who live in these areas, like Kusilvak County, Alaska and Zapata County, Texas, have to drive even farther to access care - a task that is not always feasible, especially during labor.

The type of maternal care professional available depends on where you live

Many different professionals may be involved in an expectant mother's prenatal care to ensure that the mother has a healthy pregnancy. However, the type of professionals someone has access to can depend on where they live. Our research shows that there are more family practice providers in proportion to other maternal care professionals in more rural areas.

The chart below shows the average share of maternal professionals who are family practice providers, by geography type. Counties were classified into the following geography types: (1) non-metro or micro, (2) micropolitan, (micro), or (3) metropolitan (metro). Generally, metro counties were the most urban, and non-metro or micro counties were the most rural. In non-metro or micro counties, family practice professionals made up, on average, 88% of maternal care professionals.

Family practice is a specialty that provides a large spectrum of healthcare to the general population - including prenatal care. Family practice providers can deliver critical maternal care in areas where there are fewer professionals who are trained in maternal care. In fact, research shows that family practice doctors deliver babies in 67% of rural hospitals.

However, research shows that the number of family practice doctors providing maternal care has been decreasing since 2000. And while maternal care is part of a family practice resident's training, the level of maternal care training varies by residency program. This may spell trouble for areas that depend on family practice doctors to provide maternal care.

We also found that OB-GYNs, MFM professionals, and midwives (health professionals who specialize in maternal care) were in higher supply in urban areas. In the most urban counties (metro counties), the average number of OB-GYNs, MFM professionals, and midwives per 1,000 annual births was nearly three times higher than in the most rural counties (non-metro or micro counties).

The chart below shows the number of OB-GYNs, MFM professionals, and midwives per 1,000 annual births, by geography type.

The lack of maternal care professionals translates into lack of access for women in rural areas. Research into the types of professionals that women see in rural versus urban areas shows that women in rural areas are less likely than women in urban areas to have had an OB-GYN in the past year. Though there are many reasons contributing to this disparity, the lower supply of OB-GYNs is the primary one.

Summing it up

Our research finds that mothers who lived in a county with no maternal care professionals gave birth to nearly 26,000 babies in a year. And close to 400,000 women of childbearing age lived in those same counties.

More urban areas have a higher supply of maternal-focused specialty professionals (OB-GYNs, MFMs, and midwives). While in the most rural counties, family practice providers make up 88% of the maternal care professionals.

This finding follows our Maternal Care Access series story that shows that nearly 60% of mothers who recently gave birth were not able to see all the healthcare professionals they wanted to see throughout their pregnancy, labor, and birth.

While this analysis looks specifically at geographic access to a professional, our prior report shows that having a professional in the area is just one aspect of access. Mothers could still have trouble finding care due to availability issues, such as scheduling or wait times. Some mothers even reported that they had trouble getting access to the transportation needed to see a professional.

Overall, the importance of maternal care access cannot be understated, as having prenatal care helps ensure the health of the mother and the baby during pregnancy.

Methodology

Data cleaning

Professional data:

The dataset on healthcare professionals is licensed through HealthLink Dimensions. Based in Atlanta, HealthLink Dimensions is the authority in healthcare professional data, serving hospitals, life sciences, and health insurers with innovative managed data services and enterprise engagement solutions.

Professionals were included if they (1) had 'family practice,' 'nursing - family practice,' 'maternal & fetal medicine,' 'perinatology,' 'obstetrics,' 'obstetrics & gynecology,' or 'nursing - midwife' in their specialty description; (2) were located in one of the 50 U.S. states or the District of Columbia; and (3) had an accurate location mapped to them (a professional may have more than one specialty and/or more than one active location).

We added a claim requirement because we wanted to identify professionals who specifically treated people who were pregnant. This is especially relevant for family practice professionals, who do not only treat people who are pregnant. Professionals who had a claim with an ICD-10 diagnosis code of O00-O9A (Pregnancy, Childbirth, And The Puerperium), Z32, Z34, Z36, and Z39 between September 2020 through September 2023 were included. The claims source consists of both commercial and CMS claims data covering 350 million lives and over 5 billion claims per year.

The specialty descriptions were grouped into larger specialty buckets such as:

• Family practice: 'Family practice,' 'nursing - family practice'

• MFM: 'Maternal and fetal medicine,' 'perinatology'

• OB-GYN: 'Obstetrics', 'obstetrics and gynecology'

• Midwife: 'Nursing - midwife'

Many different types of professionals can be involved in maternal care. In this analysis, we included doctors, physician associates, and advanced practice nurses for the family practice, MFM, and OB-GYN specialties. For midwives, we did not require a professional to be a specific type. The data set may undercount the number of professionals because the data is based on the NPPES NPI Registry.

We used the latitude and longitude to geolocate a professional's address to a county using Census 2023 TIGER/Line ShapeFiles.

Census data:

Data on total number of childbearing women (ages 15 to 44) by county was obtained from the American Community Survey (ACS) 2022 5-year estimates (Table B01001: Sex By Age).

Data on the total number of annual births was obtained from the US Census County Population Totals and Components of Change files. Specifically, our county of births uses the variable BIRTHS2022, which represents births in the period July 1, 2021 to June 30, 2022.

We linked a county to a core-based statistical area (also known as a geography type) using Census March 2020 Delineation files. The U.S. Office of Management and Budget (OMB) defines areas as metropolitan (metro) if they have at least one urban cluster with a total population of 50,000 or more and as micropolitan (micro) if they have at least one urban cluster of between 10,000 and 50,000 people. These metro and micro counties either have a significant portion of their population in the urban cluster or significant commuting ties to urban clusters. All other counties are neither metro nor micro. And they don't have any commuting ties to any metro or micro areas. Generally, metro counties are the most urban and non-metro or micro counties are the most rural.

Analysis

County-level estimates of maternal care professionals per 1,000 annual births were calculated by obtaining the number of distinct maternal care professionals by county, divided by the number of annual births in that same county, multiplied by 1,000.

To get the share of maternal care professionals that are family practice providers by geography type, we summed the number of distinct family practice providers and the number of distinct maternal care professionals by county, and divided the sum of family practice providers by the number of maternal care professionals. Last, we grouped the counties by geography type and took the average.

To get the number of OB-GYNs, MFMs, and midwives per 1,000 annual births (per capita rate) by geography type, we summed the number of distinct OB-GYN, MFMs or midwife professionals and the number of births by county. We calculated the per capita rate by dividing that aforementioned sum of professionals by the sum of annual births in that same geography type, multiplied by 1,000. Last, we grouped the counties by geography type and took the average.

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