"I Feel Like That Was the Only Option I Had:" A Qualitative Study of Structural Inequities in Obstetric Hospital Choice in Trenton, New Jersey

In the United States, more than 1.1 million women of childbearing age live in an urban maternity care desert. Trenton, New Jersey no longer has a hospital obstetrics (OB) unit within the bounds of the city. We sought to understand where pregnant people in Trenton gave birth, what their experiences were like, and what barriers to quality care exist for this population. In 2019, we conducted semi-structured interviews with 21 women living in Trenton who gave birth after 2011, when the city's last high-volume OB unit closed. A combination of deductive and inductive analysis was used to describe birth experiences, accessibility, and quality of care. Respondents were largely publicly insured and lacked choices for prenatal care or delivery hospital. Increased travel distance, institutional mistrust, and added impediments to emotional support at the time of delivery were chief barriers to entry into care and a quality care experience.