One-third of US health centers lack onsite prenatal care 

1. In this cross-sectional study, one-third of federally qualified health centers (FQHCs) in the United States did not provide onsite prenatal care and instead referred pregnant patients to external providers.

2. FQHCs without onsite prenatal care were more likely to be located in maternity deserts, highlighting persistent geographic disparities in access to prenatal care.

Evidence Rating Level: 3 (Average)

Study Rundown: Low-income pregnant patients face substantial barriers to prenatal care, and these inequities have worsened over the past decade. Federally qualified health centers (FQHCs) serve millions of low-income patients and play an important role in improving access to prenatal services. This study examined the national availability of onsite prenatal care at FQHCs. Approximately one-third of FQHCs did not provide onsite prenatal care and instead referred pregnant patients to external providers. Centers offering onsite prenatal care were more likely to serve populations with greater socioeconomic disadvantage, including higher proportions of Medicaid-insured patients, racial and ethnic minority groups, individuals with low incomes, and those with limited English proficiency. They were also more commonly located in urban areas and outside maternity deserts. Regional differences were evident. FQHCs in the Northeast and Pacific West were more likely to provide onsite prenatal care, whereas many counties in the South and western Midwest-regions with the greatest concentration of maternity deserts-lacked FQHCs offering onsite prenatal services or had no FQHCs at all. The study was limited by the absence of patient-level data and information on where patients received prenatal care when onsite services were unavailable. Nevertheless, the findings highlight important geographic gaps in prenatal care availability at FQHCs, particularly in maternity deserts. Further research is needed to determine whether expanding onsite prenatal services at FQHCs could improve access to and quality of perinatal care for underserved populations.

Click to read this study in AIM

Relevant Reading: Landscape of Pregnancy Care in US Community Health Centers

In-Depth [cross-sectional study]: This cross-sectional study examined the availability of onsite versus referral-only prenatal care at FQHCs across the United States. Data were obtained from the 2024 Uniform Data System, which includes all Health Resources and Services Administration-funded FQHCs, and the March of Dimes database to identify maternity deserts. Eligible FQHCs were active in 2024, served at least 100 adult female patients, and were located within the 50 states or Washington, DC. Among 1326 FQHCs serving approximately 8 million females of reproductive age, 884 (66.7%) provided onsite prenatal care, while 442 (33.3%) referred pregnant patients to external providers. Compared with referral-only centers, FQHCs offering onsite prenatal care served higher proportions of patients enrolled in Medicaid (45.4% vs 38.4%), those who were Black (20.6% vs 17.1%) or Hispanic (37.9% vs 22.3%), individuals with incomes below the federal poverty level (66.3% vs 62.7%), and patients with limited English proficiency (25.9% vs 15.2%). They were also more likely to be located in urban areas (66.2% vs 46.4%), served more females of reproductive age (7499 vs 3057 per FQHC), and were less likely to be located in maternity deserts (6.5% vs 12.5%). Regional differences were also observed. Counties in the Northeast and Pacific West were least likely to be maternity deserts and more commonly had FQHCs providing onsite prenatal care. In contrast, counties in the South and western Midwest were more likely to be maternity deserts and often lacked either FQHCs or FQHCs offering onsite prenatal care. Overall, the findings suggest that one-third of FQHCs in the United States, particularly those serving maternity deserts, do not provide onsite prenatal care.

Image: PD

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