Access to Maternity Care and Low Birth Weight among Women in Rural and Urban U.S. Counties with Higher Rates of Underweight Births

Abstract This article explores county-level low birth weight (LBW) and maternity care access in U.S. counties with at least 20 LBW births from 2013 to 2019 (the study period), examining differences by race and geographic classification. Data were accessed through March of Dimes, who collected from the National Center for Health Statistics birth files and Human Resources and Services Administration Area Health Resources Files. Out of 3,036 U.S. counties, lack of maternity care access was more common in rural versus urban counties. LBW prevalence differed significantly between levels of maternity care access, such that counties with no access to maternity care differed significantly in LBW from counties with full or moderate access. Black women in rural counties with no maternity care access had significantly higher LBW rates compared with White women. Black women and those in rural counties experience inequities in maternity care access, underscoring the need to expand maternity care provider availability in rural communities and those with larger Black populations as a strategy to reduce LBW.