{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T16:52:45Z","timestamp":1780332765790,"version":"3.54.1"},"reference-count":21,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Mobile Healthcare Association through the Mobile Health Innovation Collaborative","award":["020924-00001"],"award-info":[{"award-number":["020924-00001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Cesarean section (CS) rates have risen globally, and while an often lifesaving and necessary intervention, CS deliveries increase future maternal\/neonatal risks and are costly to both patients and healthcare systems. The U.S. Department of Health and Human Services has set a national low-risk pregnancy CS (NTSV) target of 23.9% under the Healthy People 2030 initiative. This analysis compares NTSV rates of uninsured patients receiving prenatal care from a mobile clinic to the national target and also compares overall mobile health CS rates with national and state CS rates. Through reviewing 5 years of electronic medical records, we calculated an NTSV CS rate of 25.0% among our University of Arizona Mobile Health Program prenatal patients, an uninsured and medically vulnerable patient group. This rate is similar to both the most recent Arizona state average of 23.4% and the national target of 23.9%. The MHP total CS rate is 26% over our study period, which is less than the most recent National and Arizona rates of 32.3% and 29.0%. These findings suggest that access to free prenatal care through a mobile health delivery model may contribute to favorable obstetric outcomes among uninsured individuals and have implications for addressing maternal and neonatal health inequities among those who face multiple barriers to receiving adequate prenatal care.<\/jats:p>","DOI":"10.3390\/ijerph23030288","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T11:23:45Z","timestamp":1772105025000},"page":"288","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cesarean Section Rates and Mobile Health\u2019s Role in Equitable Access to Prenatal Care"],"prefix":"10.3390","volume":"23","author":[{"given":"Nicole","family":"Person-Rennell","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85711, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5195-518X","authenticated-orcid":false,"given":"Patrick","family":"Rivers","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85711, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Hollister","sequence":"additional","affiliation":[{"name":"Department of Community, Environment, and Policy, University of Arizona, Tucson, AZ 85724, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Dinsmore","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85711, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Bratsch","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85711, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Ortiz","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85711, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen","family":"Rundell","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85711, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3480-849X","authenticated-orcid":false,"given":"Karen","family":"Lutrick","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of Arizona, Tucson, AZ 85711, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e005671","DOI":"10.1136\/bmjgh-2021-005671","article-title":"Trends and projections of caesarean section rates: Global and regional estimates","volume":"6","author":"Betran","year":"2021","journal-title":"BMJ Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1111\/1471-0528.13526","article-title":"WHO Statement on Caesarean Section Rates","volume":"123","author":"Betran","year":"2016","journal-title":"BJOG Int. J. Obstet. Gynaecol."},{"key":"ref_3","unstructured":"Centers for Disease Control and Prevention, and National Center for Health Statistics (2025, April 29). FastStats\u2014Births\u2014Method of Delivery, Available online: https:\/\/www.cdc.gov\/nchs\/fastats\/delivery.htm."},{"key":"ref_4","unstructured":"Centers for Disease Control and Prevention, and National Center for Health Statistics (2025, April 29). Vital Statistics Online Data Portal, Available online: https:\/\/www.cdc.gov\/nchs\/data_access\/vitalstatsonline.htm."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1007\/s40615-019-00652-2","article-title":"Multi-level Drivers of Disparities in Hispanic Cesarean Delivery Rates in US-Mexico Border States","volume":"7","author":"McDonald","year":"2020","journal-title":"J. Racial Ethn. Health Disparities"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"100036","DOI":"10.1016\/j.xagr.2021.100036","article-title":"Maternal education and racial\/ethnic disparities in nulliparous, term, singleton, vertex cesarean deliveries in the United States","volume":"2","author":"Eliner","year":"2022","journal-title":"AJOG Glob. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1007\/s40615-021-01057-w","article-title":"Racial and Ethnic Disparities in Cesarean Delivery and Indications Among Nulliparous, Term, Singleton, Vertex Women","volume":"9","author":"Okwandu","year":"2022","journal-title":"J. Racial Ethn. Health Disparities"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1097\/AOG.0000000000004953","article-title":"Racial and Ethnic Disparities in Primary Cesarean Birth and Adverse Outcomes Among Low-Risk Nulliparous People","volume":"140","author":"Bartal","year":"2022","journal-title":"Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1213\/ANE.0000000000007323","article-title":"The Association of the COVID-19 Pandemic With Disparities in Maternal Outcomes","volume":"140","author":"Glance","year":"2025","journal-title":"Anesth. Analg."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Begum, T., Rahman, A., Nababan, H., Hoque, D.M.E., Khan, A.F., Ali, T., and Anwar, I. (2017). Indications and determinants of caesarean section delivery: Evidence from a population-based study in Matlab, Bangladesh. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0188074"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1007\/s10995-014-1498-8","article-title":"Determinants of cesarean delivery in the US: A lifecourse approach","volume":"19","author":"Witt","year":"2015","journal-title":"Matern. Child Health J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"9748","DOI":"10.1038\/s41598-019-46153-4","article-title":"Pregnancy outcomes of women with previous caesarean sections: Secondary analysis of World Health Organization Multicountry Survey on Maternal and Newborn Health","volume":"9","author":"Kietpeerakool","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e025356","DOI":"10.1136\/bmjopen-2018-025356","article-title":"Caesarean section in uninsured women in the USA: Systematic review and meta-analysis","volume":"9","author":"Hoxha","year":"2019","journal-title":"BMJ Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s10729-005-5212-7","article-title":"Explaining source of payment differences in U.S. cesarean rates: Why do privately insured mothers receive more cesareans than mothers who are not privately insured?","volume":"8","author":"Grant","year":"2005","journal-title":"Health Care Manag. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Negrini, R., da Silva Ferreira, R.D., and Guimar\u00e3es, D.Z. (2021). Value-based care in obstetrics: Comparison between vaginal birth and caesarean section. BMC Pregnancy Childbirth, 21.","DOI":"10.1186\/s12884-021-03798-2"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Puro, N., Kelly, R.J., Bodas, M., and Feyereisen, S. (2022). Estimating the differences in Caesarean section (C-section) rates between public and privately insured mothers in Florida: A decomposition approach. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0266666"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1007\/s10995-009-0496-8","article-title":"Impact of a mobile van on prenatal care utilization and birth outcomes in Miami-Dade County","volume":"14","author":"Zhang","year":"2010","journal-title":"Matern. Child Health J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1007\/s10995-006-0174-z","article-title":"Use of a community mobile health van to increase early access to prenatal care","volume":"11","author":"Edgerley","year":"2007","journal-title":"Matern. Child Health J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/00003727-198708000-00007","article-title":"Evaluation of the effectiveness of a community-based prenatal health education program","volume":"10","author":"Anderson","year":"1987","journal-title":"Fam. Community Health"},{"key":"ref_20","unstructured":"R Core Team (2024). R: A Language and Environment for Statistical Computing, R Core Team. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e2213527","DOI":"10.1001\/jamanetworkopen.2022.13527","article-title":"Association Between the COVID-19 Pandemic and Disparities in Access to Major Surgery in the US","volume":"5","author":"Glance","year":"2022","journal-title":"JAMA Netw. Open"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/3\/288\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T11:26:33Z","timestamp":1772105193000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/3\/288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":21,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["ijerph23030288"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23030288","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]}}}