Boston’s community health backbone is quietly revealing a critical blind spot in maternal care. A new national analysis led by researchers at the Harvard Pilgrim Health Care Institute and Boston University School of Public Health examines how federally qualified health centers (FQHCs)—a safety-net model designed to deliver primary care regardless of patients’ ability to pay—support pregnancy from first appointment onward. Although these centers serve low-income and racially diverse communities at scale, their prenatal service capacity appears uneven across the country.
The study draws on data from 1,326 FQHCs operating in the United States as of 2024, excluding U.S. territories and facilities serving fewer than 100 adult women. Together, the included centers represent the vast majority of the FQHC system and serve about eight million females of reproductive age. Investigators assessed whether prenatal care is delivered on-site versus handled through outside referral pathways.
Overall, about two-thirds of FQHCs provide on-site prenatal care, while roughly one in three do not. That gap matters because prenatal visits are not just check-ins; they structure risk detection, chronic condition management, patient education, and continuity of care—elements that influence birth outcomes and maternal safety. When services are absent locally, patients may face delays in scheduling, transportation barriers, or fragmented handoffs.
The geographic pattern is especially striking. “Maternity desert” regions—areas with limited maternal health resources—often lacked FQHC presence entirely or included centers that did not offer prenatal care on-site. The result is a double bind: fewer local options and fewer direct services when women need them most.
Importantly, the study also finds that centers serving higher proportions of Black and Hispanic patients, Medicaid populations, individuals with limited English proficiency, and urban communities were more likely to provide on-site prenatal care. In other words, where prenatal services exist within the safety-net system, they disproportionately reach groups that face the greatest access barriers.
Researchers emphasize that the findings identify a practical expansion target: growing on-site capacity within FQHCs while strengthening coordinated external referral systems where on-site care is unavailable. The authors argue that addressing workforce and financial constraints will be essential for making maternal care coverage consistent.
The study further suggests a strategy for closing regional shortages, including expanding FQHC capacity in maternity care deserts using Health Resources and Services Administration (HRSA) “New Access Point” style grants. If implemented, these investments could shift prenatal access from “mostly available” to broadly dependable—especially in communities already at risk of delayed or disrupted care.
Ultimately, the work reframes FQHCs as both a critical platform and a measurable opportunity. For maternal health equity, the question is no longer whether safety-net infrastructure exists, but whether prenatal care is delivered where patients live, in the form patients can reliably reach.
Subject of Research: Prenatal care service availability at federally qualified health centers (FQHCs)
Article Title: Provision of Onsite Prenatal Care Services at U.S. Federally Qualified Health Centers
News Publication Date: 15-Jul-2026
Web References: http://dx.doi.org/10.7326/ANNALS-26-00381
References: Cole MB, Auty S, Zi Jin G, Safon C, Gordon SH. Annals of Internal Medicine. Published July 14, 2026. doi:10.7326/ANNALS-26-00381
Image Credits: Not provided in the provided content
Keywords: FQHC, prenatal care, maternal health equity, maternity deserts, Medicaid, workforce capacity, health access disparities
