Term of Award

Spring 2023

Degree Name

Doctor of Public Health in Community Health Behavior and Education (Dr.P.H.)

Document Type and Release Option

Dissertation (open access)

Copyright Statement / License for Reuse

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


College of Public Health

Committee Chair

Dr. Tilicia Mayo-Gamble

Committee Member 1

Dr. Bettye Apenteng

Committee Member 2

Dr. Samuel Opoku

Committee Member 3

Dr. Joseph Telfair

Committee Member 3 Email



Prenatal care is crucial for achieving public health and primary healthcare objectives. It is one of the goals of Healthy People 2030, which is the US federal initiative to improve the health and well-being of people nationwide. Unfortunately, despite the lofty goals, the United States has the highest maternal mortality rate among developed countries. In 2020, the maternal mortality rate in the US was 24 deaths per 100,000 live births, more than three times the rate in most high-income countries. What is concerning is that it is getting worse. Seven hundred women die of pregnancy-related complications. Among them, black and Native American women are 2 to 4 times more likely to die than white women. One of the reasons driving this maternal health crisis in the US is that not every woman has equitable access to maternity care. More than 5 million women live in maternal care deserts, counties with low access to maternal care in the US. Several other factors at individual, community, and systemic levels of the socio-ecological model affect maternal health. Personal factors like income, housing, and personal beliefs can affect a mother’s access to healthcare. At the community level, it is availability or accessibility to services, and on the systemic level, it is the number of policies aimed at maternal health. The study’s findings reveal that mothers with income greater than $90,000, government insurance, survivors of partner abuse, or have depression in states with high women’s representation in the state legislature are more likely to use prenatal care than mothers with the same conditions in states with low women’s representation in the state legislature. Therefore, under certain situations, the high representation of women in state legislature affects prenatal healthcare utilization, particularly the vulnerable population.

Research Data and Supplementary Material


EXEMPT APPROVAL H23097.pdf (103 kB)
IRB Approval