Infants Without Access to Maternal Care Exhibit High Mortality Risk

Compared with infants having full access to the maternal care they require, those without access exhibited significantly greater rates of mortality risk, according to a study published in JAMA Network Open.¹ When solely accounting for race, the only differences in mortality risk appeared when exploring white infants.

“Infant mortality is a critical indicator of a nation’s health, reflecting the social, economic, and cultural conditions that shape the lives of infants and their caregivers,” wrote the authors of the study. “The infant mortality rate (IMR; number of infant deaths per 1000 live births) measures health care quality and broader societal well-being.”

Statistics surrounding the IMR have received a keen focus from medical and health care experts because of its impact on the future generations of society. The IMR in 2022 specifically was one of the most novel years in recent history, seeing the first meaningful year-over-year increase since the previous 20 years.¹ In 2022, over 20,000 infants died, with the Black IMR being the highest at 10.9 and the White (4.5) and Asian (3.5) IMRs being the lowest.²

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Furthermore, aside from the racial/ethnic factors prominent across IMR statistics, regional trends have also been notable. According to both the current study and CDC data, the South and Midwest regions of the US are typically impacted the most regarding heightened IMRs.^1,2 There are further disparities among urban and rural locales across the US, with IMRs in rural areas superseding that of urban communities.

Whether it be geographical or racial factors, trends in the IMR across the country highlight the apparent need for equitable and high-value maternity care services accessible to all patients in need. When expecting mothers collaborate with health care providers before, during, and after their pregnancy, they are more likely to collectively contribute to a decreased IMR.

There are many barriers to access and common trends as to why certain US citizens may be lacking access to prenatal care. According to the Region V Public Health Training Center, a lack of access and the increased travel time that patients need are the biggest barriers to prenatal care in rural areas. With financial barriers following behind, these impediments to women’s essential prenatal care impact their structural, socioeconomic, sociocultural, and personal outcomes.³

Amid persistently unmet maternal health needs throughout the US, researchers of the current study investigated how access impacted the IMR over time.

“This study investigates the association between infant mortality and access to maternity care, using March of Dimes’ maternity care access designations,” they continued.¹ “We aim to determine whether infants born to birthing people in areas with no or limited access to maternity care are at an increased risk of death and whether risk varies by race and ethnicity or timing of death.”

Through the use of National Center for Health Statistics data, researchers explored the IMR from 2017 to 2021 across all US states and DC. The study’s primary exposure was county-level access to maternity care services facilitated through March of Dimes programming. The primary outcome was infant mortality, defined as a death occurring in the first year of life.

“These designations categorized counties as maternity care deserts or low, moderate, or full access based on 3 factors: availability of obstetric hospitals and birth centers, ratio of obstetric clinicians to births, and proportion of uninsured women aged 19 to 54 years,” the authors wrote.¹ “For this analysis, we use the term no-access counties in place of maternity care deserts to improve clarity and acknowledge the limitations of the term deserts in this context.”

The final analysis included a total of 18,682,916 live births (51.4% white maternal patients; 29.2% aged 30 to 34 years) from 2017 to 2021.

Amid the full spectrum of access to maternal care services, the IMR demonstrated a significant association with access to prenatal care. Unsurprisingly, IMRs increased further as access to care decreased. Researchers also reported the highest IMRs in counties with no access and the lowest IMRs in counties with full access, deliberately highlighting maternal care disparities.

When researchers separated IMRs specifically by race and time of death, disparities in access were only uncovered among white patients. Across this population, the IMR was much higher among white patients with no access compared with white patients with full access. No significant findings were uncovered when separating by time of death.

“These elevated rates underscore the impact of historical marginalization and systemic racism on health outcomes, transcending the availability of care,” concluded the authors.¹ “Expanding access is necessary but insufficient; solutions must address the broader social and economic conditions that shape maternal and infant health.”

READ MORE: Women’s Health Resource Center

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REFERENCES

1. Lucas R, Thames T, Chestnut JF, et al. Maternity care access and infant mortality. JAMA Netw Open. 2025;8(11):e2542831. doi:10.1001/jamanetworkopen.2025.42831

2. Infant mortality. CDC. September 16, 2024. Accessed November 17, 2025. https://www.cdc.gov/maternal-infant-health/infant-mortality/index.html

3. Maternal and infant mortality: barriers to prenatal care. Region V Public Health Training Center. May 3, 2024. Accessed November 17, 2025. https://www.rvphtc.org/2024/05/03/maternal-and-infant-mortality-barriers-to-prenatal-care/