HMN 2026: How Most community health centers provide prenatal care, but one-third still lack services

A new national study provides the first comprehensive look at prenatal care services offered by federally qualified health centers (FQHCs), revealing that while these safety-net providers play a critical role in caring for low-income and racially diverse pregnant populations, significant gaps in access remain. The work is published in the journal Annals of Internal Medicine.

Researchers from the Harvard Pilgrim Health Care Institute and the Boston University School of Public Health found that about two-thirds of centers offer prenatal care, while one in three does not—pointing to missed opportunities to address inequities in maternal health access.

Addressing a critical knowledge gap

Low-income pregnant and postpartum patients face growing barriers to accessing care, driven in part by maternity ward closures and a growing shortage of providers over the past decade. Serving more than 32 million low-income patients nationwide, FQHCs—also known as community health centers—are uniquely positioned to help address these challenges because they offer comprehensive primary care regardless of ability to pay and are required to be located in underserved communities. FQHCs may either provide prenatal care onsite or refer patients to external providers, and until now, national data on these patterns have been limited.

“Despite the potential for FQHCs to address maternal health access barriers, we actually know little about the extent to which they directly provide maternal health services,” said Megan Cole Brahim, lead author and Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute. “Understanding where and for whom these services are available is essential to improving maternal health equity.”

Study design and scope

The study analyzed data from 1,326 federally qualified health centers across the United States, representing 100% of FQHCs in operation as of 2024 (excluding U.S. territories and centers serving fewer than 100 adult female patients). Together, these centers serve approximately 8 million females of reproductive age.

Researchers assessed the availability of onsite prenatal care at FQHCs, characteristics of centers offering onsite care and geographic variation in the availability of onsite prenatal care, including whether an FQHC was located in a “maternity desert” region.

Key findings

The study revealed several key findings:

• Important role in providing prenatal care, but significant gaps in access remain: Two in three FQHCs offer onsite prenatal care, while one in three FQHCs does not.
• Geographic disparities: Maternity deserts often lacked FQHCs altogether or had centers that did not provide onsite prenatal care.
• Equity-focused care delivery: FQHCs serving higher proportions of Black and Hispanic patients, Medicaid populations, those with limited English proficiency and urban communities were more likely to offer prenatal care, suggesting that FQHCs provide maternal health care services to populations that often face the greatest access barriers.

FQHCs play a critical role, but have room to reach their full potential

The findings, Brahim notes, underscore both the critical role of FQHCs and the need for expanded access to prenatal care within the safety net they provide.

“With one in three FQHCs lacking prenatal services, expanding onsite prenatal care at FQHCs—and addressing the workforce and financial barriers that currently hinder this expansion—must be a priority. At the same time, ensuring that patients can access timely, coordinated external referrals when onsite prenatal care is unavailable is critical,” adds Brahim. “Strategically growing health centers in maternity care deserts—potentially through HRSA ‘New Access Point’ FQHC capacity-building grants—could be a critical step toward closing these gaps.”

As maternal health disparities persist nationwide, the study highlights an urgent opportunity to strengthen access through proven safety-net providers. Targeted investments in community health centers could play a pivotal role in ensuring equitable, timely prenatal care for all patients.

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