Systematic review of barriers to maternal healthcare access and effective interventions in the United States

BackgroundThe United States faces a profound maternal health crisis despite its global economic standing, with maternal mortality rates significantly higher than other high-income countries and stark disparities across racial and ethnic lines. This systematic literature review aims to synthesize current evidence on barriers to maternal healthcare access, resulting health outcomes, and effective interventions for reducing disparities.MethodsFollowing PRISMA guidelines, a comprehensive search was conducted across PubMed, Web of Science, and ProQuest for literature published January 2000 and December 2024. The initial search yielded 122,756 records, which were narrowed to 44 studies for final synthesis after applying inclusion/exclusion criteria. Thematic analysis identified patterns related to barriers, outcomes, and interventions in maternal healthcare.ResultsThe systematic search identified 44 studies for synthesis. Analysis revealed five major barrier categories affecting maternal healthcare access: financial (24 references), systematic (34 references), educational (6 references), geographical (17 references), and comorbidity-related (1 reference). These barriers contributed to concerning disparities in maternal health outcomes, with Black women experiencing mortality rates 3-4 times higher than White women. Promising interventions included safety net providers (such as community health centers, mental health teams), culturally sensitive approaches, healthcare workers (doulas, translators), predictive models, special initiatives, and policy changes (Medicaid expansion, telehealth).ConclusionAddressing the U.S. maternal health crisis requires coordinated action targeting multifaceted barriers and implementing evidence-based interventions. Recommendations include expanding Medicaid coverage beyond the current postpartum limit, implementing approaches addressing social determinants of health, integrating diverse healthcare workers into maternal care teams, and prioritizing culturally sensitive, patient-informed care while actively addressing systematic barriers, particularly racism and discrimination.