September 10, 2025
The role of family physicians in America’s maternal healthcare deserts
University of Washington researchers Dr. Mae Dirac and Dr. Emily Godfrey are leading a project funded by the UW Population Health Initiative to investigate how family physicians impact maternal health outcomes in America’s “maternal care deserts” – counties lacking basic obstetrical services.
America’s maternal healthcare crisis stands as the worst among wealthy nations, with particularly devastating effects on Black women, who stand three times as likely to die from pregnancy-related causes than white women. The research aims to shine a spotlight on the role of family physicians in these care deserts.
“Family physicians are the largest specialty across the entire United States and are the largest group of the nation’s rural obstetrical providers,” explains Dr. Godfrey, who holds appointments in both Family Medicine and Obstetrics and Gynecology at the University of Washington Medical Center. “If we got rid of family physicians, there would be huge gaps in care.” Only 6% of counties in the U.S. do not have a family physician, compared to 40% of counties without an obstetrician or certified nurse midwife.
The study compares maternal mortality, stillbirth and low birth weight frequency between counties that have no obstetrical providers versus those where family physicians provide obstetrical care. Working with the Robert Graham Center, a policy study center of the American Academy of Family Physicians, the researchers are evaluating data from 2011-2019 across 1,124 counties designated as maternal care deserts.
“Different communities have different local norms around whether family physicians provide obstetric care,” notes Dr. Dirac, assistant professor of Health Metrics Sciences and Family Medicine. “They’re much more likely to do so in maternity care deserts in the middle and western parts of the country.”
The project employs sophisticated methodologies, using maternal mortality and natality data from the National Vital Statistics System coupled with the Maternal Vulnerability Index and county-level demographic data to control for confounding factors. The research is particularly significant because until recently, family physicians were not counted as obstetrical providers in maternal care deserts, despite being the sole maternity care clinicians in 16.2% of these counties.
Beyond the immediate focus on delivery, the researchers emphasize family physicians’ broader impact on maternal health. “The role of family physicians is so much bigger than the actual pregnancy and delivery,” Dr. Godfrey notes. “Having access to primary care and to a provider who provides comprehensive contraception means you’re avoiding pregnancies that may otherwise result in death.”
Family physicians also provide longitudinal care following pregnancy, and other research studies reveal mental health issues as a leading driver of maternal mortality. Dr. Godfrey explains, “Suicide is the number one cause of death within the first year after delivery of a baby,” which underscores the importance of having a consistent and trusted healthcare provider that follows patients through their entire maternal journey.
The findings will guide policies regarding training, recruitment, retention and institutional support for family physicians providing obstetric care in underserved areas. This project represents the first step in a larger research agenda examining various contributions of family medicine to maternal health outcomes — including treatment of pre-pregnancy conditions and prevention of unintended pregnancy.
As Dr. Godfrey concluded, “It’s really primary care that’s often saving our population” – not through dramatic interventions that make headlines, but through measured, comprehensive care focused on prevention. The long-term relationships family physicians build with patients may be their most powerful tool in combating maternal mortality, allowing them to address important maternal health concerns before, during and long after pregnancy.