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Background and Objectives: In 2011, the American Public Health Association (APHA) passed legislation aimed at reducing maternal mortality and morbidity by addressing shortages in maternity care providers and facilities. The purpose of this study was to examine county-level characteristics that influence Black women’s access to midwife-attended births across the U.S. Methods and Approach: Data on midwife-attended births were obtained from CDC WONDER for U.S. counties with populations of 100,000 or greater, and county-level characteristics were gathered from the Area Health Resources File. The dependent variable was the change in nurse-midwife-attended births from 2011 to 2023. Independent variables included changes in midwifery and obstetrician workforce densities, percent of women using Medicaid, percent of the population identifying as Black, percent of women with pregnancy risk factors (diabetes and preterm births), and percent of preterm births. Descriptive statistics and linear regression analyses were conducted to assess associations between these variables. Results: Increased midwife density was positively associated with the rate of Black midwife-attended births, while greater obstetrician density and socioeconomic disadvantage were associated with lower rates. Two factors from the Social Vulnerability Index also showed relationships, though interpretation was limited due to variable complexity. Conclusions and Broader Implications: Access to midwifery care for Black women is shaped by workforce availability and structural barriers. Future research should examine how hospital policies, insurance coverage, and Medicaid expansion influence access. Expanding midwifery services in underserved areas may help reduce maternal health disparities and improve outcomes for Black mothers.

Publisher Location

Las Vegas (Nev.)

Publication Date

Fall 11-21-2025

Publisher

University of Nevada, Las Vegas

Language

English

Keywords

Nurse Midwifery; Black Women; Health Care; Midwives; Barriers

Disciplines

Medicine and Health Sciences | Nursing

File Format

PDF

File Size

335 KB

Permissions

Google Drive\Institutional Repository\OUR_OfficeOfUGResearch\Symposia\2025 Fall Symposium

Comments

Mentor: Melva Thompson-Robinson

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

Examining County-level Barriers to Midwife-Attended Births Among Black Women in the United States


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