Maternity Care Desert in United States

United States

People who live in maternity care deserts face heightened maternal health risks, including poorer preconception health, reduced prenatal care and elevated rates of preterm birth. March of Dimes defines a maternity care desert as a county with no obstetric providers and no hospital or birth center that provides obstetric care. In 2022, more than 150,000 babies in the United States were born in maternity care deserts, and approximately 2.3 million women of reproductive age were living in maternity care deserts.

The U.S. has the highest maternal mortality rate among high-income countries. The lack of maternity care is an important and growing issue, with more than 35% of U.S. counties designated as maternity care deserts. An estimated 87% of pregnancy-related deaths are preventable, and improving access to maternity care could significantly reduce maternal and pregnancy-related mortality. 

Obstetric unit and hospital closures in rural areas have contributed to the spread of maternity care deserts — 97.7% of all live births occur in hospitals, and 107 hospitals closed in the U.S. between 2021 and 2022. A 2021 study found that 25% of rural hospitals surveyed were unsure whether they would continue to provide obstetric services.

Geographical and demographic characteristics associated with very low maternity care access include:

• Lacking health insurance.
• Living in counties with a lower median household income.
• Living in rural areas, where fewer providers and frequent hospital closures limit access to care.

Strategies to address maternal health workforce challenges include expanding access to community-based pregnancy and childbirth care and covering doula services in state Medicaid plans. 

March of Dimes recommends multiple strategies for improving access to preconception, prenatal and postpartum care, including:

• Extending Medicaid eligibility and coverage to people with incomes at or below 138% of the federal poverty level.
• Extending the Medicaid postpartum coverage period in all states to 12 months.

Healthy People 2030 does not explicitly address maternity care deserts but has multiple objectives related to pregnancy and childbirth, including:

• Increasing the proportion of pregnant women who receive early and adequate prenatal care.
• Reducing maternal deaths.

Gunja, Munira Z., Evan D. Gumas, Relebohile Masitha, and Laurie C. Zephyrin. Insights into the U.S. Maternal Mortality Crisis: An International Comparison. Issue Brief. Commonwealth Fund, June 4, 2024. https://doi.org/10.26099/cthn-st75.

Kozhimannil, Katy B., Julia D. Interrante, Lindsay K. Admon, and Bridget L. Basile Ibrahim. “Rural Hospital Administrators’ Beliefs About Safety, Financial Viability, and Community Need for Offering Obstetric Care.” JAMA Health Forum 3, no. 3 (March 25, 2022): e220204. https://doi.org/10.1001/jamahealthforum.2022.0204.

Stoneburner, Ashley, Ripley Lucas, Jazmin Fontenot, Christina Brigance, Erin Jones, and Andrea L. DeMaria. Nowhere to Go: Maternity Care Deserts Across the US. Report No. 4. March of Dimes, 2024. https://www.marchofdimes.org/peristats/assets/s3/reports/2024-Maternity-Care-Report.pdf.

Wallace, Maeve, Lauren Dyer, Erica Felker-Kantor, Jia Benno, Dovile Vilda, Emily Harville, and Katherine Theall. “Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana.” Women’s Health Issues 31, no. 2 (March 2021): 122–29. https://doi.org/10.1016/j.whi.2020.09.004.