First Advisor

Deborah Karasek

Date of Award

Spring 6-2026

Document Type

Thesis

Degree Name

Bachelor of Science (B.S.) in Public Health Studies: Health Administration Services

Department

OHSU-PSU School of Public Health

Language

English

Subjects

Maternity Care Deserts, Systems Thinking, Rural Health Equity, Bivariate Choropleth Mapping, Prenatal Care Adequacy, Oregon.

Abstract

Abstract: 

Objectives: In Oregon, 51% of hospitals providing labor and delivery services are located in rural areas. Consolidation of these hospitals and provider shortages has created severe geographic and systemic disparities in maternal healthcare. This thesis explores how geographic isolation and inadequate prenatal care access contribute to widening disparities in severe maternal morbidity (SMM) and mortality across Oregon’s rural and frontier counties.

Methods:  This study utilizes data from the Oregon Health Authority (OHA) Center for Health Statistics (2024) and analyzes spatial correlations across all 36 Oregon counties. A bivariate choropleth map was constructed to examine the structural intersection between health infrastructure (Obstetric Specialist Density) and clinical utilization outcomes (Inadequate Care, Low Birth Rate, Primary Delivery Attendant, 1st Trimester Entry, and Systemic Profile & Access Analysis Table).

Results: The analysis reveals that specialist density does not dictate care adequacy. Klamath County emerged as a critical outcome, with a 26.7% care inadequacy rate despite medium specialist density. In opposition, Wallowa, which has a 2.4% inadequacy, and Harney counties were identified as positive deviants, with low specialist density but achieving high care adequacy through integrated family medicine and midwifery frameworks. However, Maternity care deserts with zero local specialists and extreme geographic isolation (Morrow and Curry counties) directly correlated with severe care disruptions and elevated inadequacy rates.

Conclusion: The process to improve maternal health equity in rural and frontier regions requires a change in perspective. There's no single model that will fit all rural communities in Oregon. Ultimately, policy interventions must support integrated primary care networks, stabilize rural workforce retention, and mitigate administrative and geographic barriers to care entry.

Download

Share

COinS