Maternity Care Desert in Alabama

Alabama

Women who give birth in maternity care deserts may be less likely to receive adequate prenatal care and treatment for pregnancy complications and are more likely to die during childbirth. March of Dimes defines a maternity care desert as a county that lacks both a hospital or birth center providing obstetric care and any obstetric providers. In 2020, more than 146,000 babies were born in maternity care deserts, and 2.2 million women of reproductive age were living in maternity care deserts.

The United States has the highest maternal mortality rate of any high-income country and maternity care deserts are an important and growing issue, with 36% of all U.S. counties designated as maternity care deserts. Improving access to maternity care could significantly reduce maternal and pregnancy-related mortality, as an estimated 84% of pregnancy-related deaths are preventable. 

Obstetric unit and hospital closures in rural areas have contributed to the spread of maternity care deserts — 98.3% of all live births occur in hospitals and 181 rural hospitals closed in the U.S. between 2005 and 2022. A 2021 study found that 25% of rural hospitals surveyed were unsure if they would continue providing obstetric services.

Populations more likely to live in maternity care deserts include: 

• Women who live in rural areas compared with those in urban areas. Within rural areas, the most remote counties have experienced the most frequent closures of hospital maternity wards.
• Women living in counties below the national median household income. 
• Women living in areas with low access to telehealth.

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. The 2023 presidential budget allocated $470 million towards reducing maternal mortality, including funding for implicit bias training for health care providers and support for the perinatal health workforce. The White House Blueprint for Addressing the Maternal Health Crisis aims to increase access to and coverage of comprehensive, high-quality maternal health services, including behavioral health services. It explicitly names maternity care deserts as a barrier to reaching this goal.

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

• Expanding Medicaid eligibility and coverage for individuals who fall at or below 138% of the federal poverty level.
• Raising parental income eligibility levels under Medicaid.
• 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 and reducing maternal deaths.

Christina Brigance, Ann Davis, Zsakeba Henderson, Erin Jones, Ripley Lucas, and Kate Mishkin. “Nowhere to Go: Maternity Care Deserts Across the U.S.” March of Dimes, 2022. https://www.marchofdimes.org/sites/default/files/2022-10/2022_Maternity_Care_Report.pdf.

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

Kozhimannil, Katy Backes, Julia D. Interrante, Carrie Henning-Smith, and Lindsay K. Admon. “Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007–15.” Health Affairs 38, no. 12 (December 1, 2019): 2077–85. https://doi.org/10.1377/hlthaff.2019.00805.

Trost, Susanna, Jennifer Beauregard, Gyan Chandra, Fanny Njie, Jasmine Berry, Alyssa Harvey, and David A. Goodman. “Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017–2019.” Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2022. https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html.

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.

“White House Blueprint for Addressing the Maternal Health Crisis.” Washington, D.C.: The White House, June 2022. https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf.