The implications of using maternity care deserts to measure progress in access to obstetric care: A mixed-integer optimization analysis

Abstract

AbstractBackgroundAmong the factors contributing to the maternal mortality crisis in the United States is a lack of risk-appropriate access to obstetric care. There are several existing measures of access to obstetric care in the literature and popular media. In this study, we explored how current measures of obstetric access inform the number and location of additional obstetric care facilities required to improve access.MethodsWe formulated two facility location optimization models to determine the number of new facilities required to minimize the number of reproductive-aged women living in obstetric care deserts. We define deserts as either “maternity care deserts”, designated by the March of Dimes to be counties with no obstetric care hospital or obstetric providers, or regions further than 50 miles from critical care obstetric (CCO) services. We gathered information on hospitals with obstetric services from Georgia Department of Public Health public reports and estimated the female reproductive-age population by census block group using the American Community Survey.ResultsOut of the 1,910,308 reproductive-aged women who live in Georgia, 104,158 (5.5%) live in maternity care deserts, 150,563 (7.9%) reproductive-aged women live further than 50 miles from CCO services, and 38,202 (2.0%) live in both “maternity care desert” and further than 50 miles from CCO services. Our optimization analysis suggests that 16 new obstetric facilities (a 19% increase from the current 83 facilities) are required to reduce the number of reproductive-aged women living in “maternity care deserts” by 50% (from 104,158 to 51,477). At least 56 new obstetric care facilities (a 67% increase) would be required to eliminate maternity care deserts in Georgia. Meanwhile, expansion of 2 obstetric care facilities to offer CCO services would reduce the number of reproductive-aged women living further than 50 miles from CCO services by 50% (from 150,563 to 57,338), and 8 facilities would ensure all women in Georgia live within 50 miles of CCO services.ConclusionsCurrent measures of access to obstetric care may not be sufficient for evaluating access and tracking progress toward improvements. In a state like Georgia with a large number of small counties, eliminating maternity care deserts would require a prohibitively large number of new obstetric care facilities. This work suggests that additional measures and tools are needed to estimate the number and type of obstetric care facilities that best match practical resources to obstetric care needs.