Term of Award

Summer 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

Joseph Telfair

Committee Member 1

Bettye Apenteng

Committee Member 2

Logan Cowan


Maternal mortality is a continuing issue, with rates for the state of Georgia (3.7 per 100,000 live births) are higher than that of the US rates (2.9 per 100,000 per live births) (Centers for Disease Control and Prevention, National Center for Health Statistics, n.d., 2023). However, maternal mortality may not account for health disparity factors, apart from access to quality care and physiological issues, which is a factor in pregnancy-related deaths, Pregnancy-related death, as defined by the US Centers for Disease and Control (CDC), is a death of a woman that occurs during or within one year of pregnancy that can be attributed to a complication, events initiated, or the aggravation of an unrelated condition by the physiologic effects of pregnancy. This mixed data study used secondary data using the Andersen healthcare utilization model to explore factors that may delay early prenatal care utilization in individuals with pre-existing hypertension who live in rural and medically underserved Georgia, which may increase the risk of pregnancy-related complications or death. The quantitative portion of this study did give some insight into the factors of importance that may influence the attainment of early prenatal care visits for individuals with pre-existing hypertension who were of a minority race compared to their white counterparts, regardless of insurance coverage before or during pregnancy particularly seen in individuals of rural county residence. The qualitative portion of this study highlighted some of the ongoing issues, such as support from leadership, changes in practices and policies, among others, and areas for needs of improvement to give adequate care for individuals with pregnancies that are categorized as high-risk in rural communities. Findings from this study will be helpful in setting a foundation for further research to address barriers for individuals with chronic hypertension prior to pregnancy and healthcare utilization.

Research Data and Supplementary Material