Strengthening the Maternal Continuum of Care in New York City: Structural Conditions Shaping Access, Continuity, and Infrastructure

Town+Gown@DDC, a NYC-wide action research program, partnered with NYU Wagner Capstone students to analyze how community-based maternal care infrastructure can be strengthened in New York City. Successful maternal outcomes depend on full continuity across prenatal, birth, and postpartum care, yet neighborhoods facing the highest risks often lack sustainable infrastructure. Our team was asked to assess the structural conditions that determine whether maternal care sites can expand, remain operational, and be financially viable. We conducted policy, finance, and regulatory analyses; compared models across FQHC/DOHMH clinics, Article 28 facilities, and other maternal service locations. We also conducted numerous stakeholder interviews with health systems, community providers, maternal care leaders, and finance/architectural experts. Through this work, our team discovered a viability trap constraining expansion: payment systems designed to reward delivery over continuity, regulatory pathways that create pre-operational risk, and capital barriers that limit provider access. Final deliverables include implementation-ready recommendations, a feasibility tool for Town+Gown to evaluate maternal care models/expansion pathways, and priority areas for further research.