Maternity Care Desert in Missouri

Missouri

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 2022, more than 150,000 babies were born in maternity care deserts, and 2.3 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 35% 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 87% of pregnancy-related deaths are preventable. 

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 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.
• Women living in counties below the national median household income. 
• Women who are uninsured compared with those with insurance.

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:

• Expanding Medicaid eligibility and coverage for individuals who fall 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. The Commonwealth Fund, June 2024. https://doi.org/10.26099/cthn-st75.

Stoneburner, A, R Lucas, J Fontenot, C Brigance, E Jones, and AL DeMaria. Nowhere to Go: Maternity Care Deserts Across the U.S. 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.