Drivers of care and outcomes for people facing fetal conditions in the United States: a conceptual framework

Abstract

Congenital anomalies, affecting 3–5% of pregnancies annually in the United States, are a leading cause of fetal and infant mortality. Despite advancements in fetal care, disparities in care access, quality, and outcomes persist and remain poorly understood. This perspective introduces the Fetal Condition Care and Outcomes (FCCO) Framework, a conceptual model that integrates contextual, individual, structural, and process-level factors influencing care and outcomes. We build on prior adaptations of Andersen’s Behavioral Model of Health Service Use and the Donabedian Structure, Process, and Outcomes Model, expanding their application from risk-appropriate neonatal care to individuals’ whose pregnancies are complicated by severe fetal conditions. By synthesizing evidence across disciplines, we highlight critical gaps in understanding the drivers of disparities, including barriers to timely diagnosis, variations in counseling practices, and inequities in access to specialized services. This article calls for interdisciplinary research to ensure risk-appropriate, person-centered care for this high-risk population.