Cesarean Section Rates and Mobile Health’s Role in Equitable Access to Prenatal Care

Highlights: Public health relevance—How does this work relate to a public health issue? Cesarean section (CS) rates have risen globally, and while an often lifesaving and necessary intervention, CS deliveries increase future maternal/neonatal risks and are costly to both patients and healthcare systems. This work examines CS rates in the setting of a free mobile health clinic for uninsured patients. Public health significance—Why is this work of significance to public health? The provision of maternity care in a mobile healthcare setting has not been significantly evaluated in the literature, and this work would add data regarding the quality of maternity care provision using standardized outcomes in the setting of maternity care, specific to mobile healthcare. This work examines CS rates in a free mobile health clinic for uninsured patients to examine quality obstetric metrics and evaluate if this clinical work is consistent with low/at goal CS rates. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? These findings suggest that access to free prenatal care through a mobile health delivery model may contribute to favorable obstetric outcomes among uninsured individuals and have implications for addressing maternal and neonatal health inequities among those who face multiple barriers to receiving adequate prenatal care. Supporting mobile clinics targeting uninsured or other vulnerable groups may provide a method of meeting national CS targets and average rates in a higher-risk population. Cesarean section (CS) rates have risen globally, and while an often lifesaving and necessary intervention, CS deliveries increase future maternal/neonatal risks and are costly to both patients and healthcare systems. The U.S. Department of Health and Human Services has set a national low-risk pregnancy CS (NTSV) target of 23.9% under the Healthy People 2030 initiative. This analysis compares NTSV rates of uninsured patients receiving prenatal care from a mobile clinic to the national target and also compares overall mobile health CS rates with national and state CS rates. Through reviewing 5 years of electronic medical records, we calculated an NTSV CS rate of 25.0% among our University of Arizona Mobile Health Program prenatal patients, an uninsured and medically vulnerable patient group. This rate is similar to both the most recent Arizona state average of 23.4% and the national target of 23.9%. The MHP total CS rate is 26% over our study period, which is less than the most recent National and Arizona rates of 32.3% and 29.0%. These findings suggest that access to free prenatal care through a mobile health delivery model may contribute to favorable obstetric outcomes among uninsured individuals and have implications for addressing maternal and neonatal health inequities among those who face multiple barriers to receiving adequate prenatal care.