Date of Conferral

2-18-2026

Degree

Ph.D.

School

Health Sciences

Advisor

Dr. Michael Furukawa

Abstract

Maternal mortality remains a significant challenge in the United States with substantial variation across counties reflecting differences in health care delivery systems and access to obstetric services. Fragmented obstetric care networks, hospital closures, and geographic barriers to care contribute to delays in prenatal and emergency obstetric services, increasing the risk of preventable maternal deaths. Guided by the social determinants of health (SDOH) framework, this quantitative cross-sectional health services study examined relationships between transportation availability, obstetric care access, and county-level maternal mortality in the United States. A national scope was required to achieve an adequate analytic sample size, as maternal mortality data were available for 187 counties nationwide, supporting sufficient statistical power and alignment with the study’s multivariable regression design. The study focused on structural health care access conditions rather than individual-level risk factors. Secondary data were obtained from the 2020 SDOH County 1.0 data set and were analyzed using descriptive statistics, Pearson correlations, and multiple linear regression while controlling for county-level socioeconomic status, racial composition, and rurality. Greater distance to obstetric care significantly predicted higher county-level maternal mortality (B = .049, p = .002), whereas transportation availability was not an independent predictor, indicating that disparities were driven by gaps in obstetric service availability (race, income, rurality). The study may contribute to positive social change by informing health services planning, guiding resource allocation, and supporting policies to strengthen obstetric care infrastructure and reduce preventable maternal deaths nationally.

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