Birth Settings in America: Outcomes, Quality, Access, and Choice

Washington (DC): National Academies Press (US); 2020 Feb 6.


The delivery of high quality and equitable care for both mothers and newborns is complex and requires efforts across many sectors. The United States spends more on childbirth than any other country in the world, yet outcomes are worse than other high-resource countries, and even worse for Black and Native American women. There are a variety of factors that influence childbirth, including social determinants such as income, educational levels, access to care, financing, transportation, structural racism and geographic variability in birth settings. It is important to reevaluate the United States' approach to maternal and newborn care through the lens of these factors across multiple disciplines. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and access to and choice of birth settings.

Publication types

  • Review

Grants and funding

This activity was supported by contracts between the National Academy of Sciences and National Institutes of Health (#HHSN26300013). Support for the work of the Board on Children, Youth and Families is provided primarily by grants from the Heising-Simons Foundation (award number 2016-210), Jacobs Foundation (award number 2015-1168), and the Marguerite Casey Foundation (award number 2018-245). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.