Public Health in the Rockies 2026

Background: Access to maternal healthcare is essential for strong maternal and infant health, yet rural communities often face barriers to adequate care. This study investigates how maternal healthcare accessibility varies by rurality across Colorado counties and its impact on birth outcomes. We hypothesize that greater distance traveled to access maternal healthcare is associated with poorer birth outcomes, proving a need for addressing this lack in health equity.

Methods: Using county-level data from the Colorado Department of Public Health and Environment (CDPHE) and the Colorado Hospital Association (CHA), we analyzed distance traveled to maternal healthcare facilities, rurality classifications, and infant health outcomes during the period between 2015 and 2024. We assessed the relationship between distance traveled and annual birth defects and preterm birth counts by county using Quasi-Poisson regression models, adjusting for county-level percentage of Women, Infants, and Children (WIC) participation, percentage of births on Medicaid, and an offset for all annual births in each county.

Results: Distance traveled to access maternal healthcare is higher among rural counties (median = 40 miles) compared to urban counties (median = 5 miles). Quasi-Poisson models indicated that an interquartile range (IQR) increase in distance traveled (32 miles) was associated with a 24% increase (95% confidence interval (CI): 0.5%, 53%) in birth defects and a 5.5% increase (95% CI: 0.8%, 10%) in preterm births in rural counties. Corresponding results for urban counterparts were attenuated.

Implications: Our findings indicate that limited access to maternal healthcare independently predicts poorer birth outcomes. Maternal care deserts are predominantly located in rural areas, and our research underscores geographic disparities as a key driver of health inequities affecting rural Colorado families. These findings demonstrate the need for public health efforts toward fostering equitable maternal and infant health outcomes across Colorado.