Maternity care access, quality, and outcomes: A systems-level perspective on research, clinical, and policy needs

Semin Perinatol. 2017 Oct;41(6):367-374. doi: 10.1053/j.semperi.2017.07.005. Epub 2017 Sep 8.


The quality of maternity care in the United States is variable, and access to care is tenuous for rural residents, low-income individuals, and people of color. Without accessible, timely, and high-quality care, certain clinical and sociodemographic characteristics of individuals may render them more vulnerable to poor birth outcomes. However, risk factors for poor birth outcomes do not occur in a vaccum; rather, health care financing, delivery, and organization as well as the policy environment shape the context in which patients seek and receive maternity care. This paper describes the relationship between access and quality in maternity care and offers a systems-level perspective on the innovations and strategies needed in research, clinical care, and policy to improve equity in maternal and infant health.

Keywords: Access; Birth outcomes; Disparities; Equity; Maternity care; Quality; Race; Rural health.

Publication types

  • Review

MeSH terms

  • Delivery of Health Care*
  • Female
  • Health Policy*
  • Health Services Accessibility*
  • Health Services Needs and Demand
  • Healthcare Financing
  • Humans
  • Maternal Health Services*
  • Outcome Assessment, Health Care
  • Patient Acceptance of Health Care
  • Pregnancy
  • Quality of Health Care*
  • Research*
  • United States