Maternity Care Desert in United States

United States

According to March of Dimes, a maternity care desert is defined as a county without a hospital or birth center offering obstetric care and with no obstetric providers. Maternity care deserts are an important and growing issue — the United States has the highest maternal mortality rate of any developed country, with 36% of all U.S. counties designated as maternity care deserts. Improving access to maternity care could significantly reduce maternal mortality, about 84% of pregnancy-related deaths are preventable. 

In 2020, more than 146,000 babies were born in maternity care deserts and 2.2 million women of reproductive age lived in maternity care deserts. 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. 

Closures of obstetric units and entire hospitals in rural areas contributed to the spread of maternity care deserts — 98.3% of all live births occur in hospitals, and 181 rural hospitals have closed in the U.S. since 2005. A 2021 survey found that 25% of surveyed rural hospitals were unsure if they would continue providing obstetric services. 

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, and mentions explicitly maternity care deserts as a barrier to reaching this goal.

Populations more likely to live in maternity care deserts include:

• White women make up most women living in maternity care deserts, however, American Indian/Alaska Native and Black women are disproportionately affected.
• Women who live in rural areas compared with women who live in urban areas. Within rural areas, the most remote counties had maternity wards in hospitals close more frequently.
• Women living in counties below the national median household income.
• Women living in areas with low access to telehealth.
• Women living in states with abortion restrictions compared with women living in states where abortion is accessible.

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 allocates $470 million towards efforts to reduce maternal mortality, including implicit bias training for health care providers and support for the perinatal health workforce.

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 specifically 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.

Declercq, Eugene, Ruby Barnard-Mayers, Laurie Zephyrin, and Kay Johnson. 2022. “The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions.” Issue Brief. The Commonwealth Fund. https://doi.org/10.26099/z7dz-8211.

Kozhimannil, Katy Backes, Julia D. Interrante, Carrie Henning-Smith, and Lindsay K. Admon. 2019. “Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007–15.” Health Affairs 38 (12): 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. 2022. “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. 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. 2021. “Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana.” Women’s Health Issues 31 (2): 122–29. https://doi.org/10.1016/j.whi.2020.09.004.

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