America’s Maternity Care Deserts: A Growing Crisis
Access to maternity care in the United States is decreasing, especially in areas where it is most desperately needed. According to the March of Dimes' 2024 Report Card, 36% of U.S. counties are classified as “maternity care deserts.” These areas lack obstetric providers, leaving more than 6 million women of childbearing age with limited or no access to essential maternity services. The ripple effects of this crisis are devastating, particularly for rural communities and people of color.
Maternity Care Deserts: Who is Affected?
The lack of maternity care disproportionately harms vulnerable populations. In 2023, one in four Native American babies and one in six Black babies were born in areas with limited or no maternity services. These disparities have dire consequences for maternal and infant health. Mothers and babies in maternity care deserts face significantly higher risks of poor health outcomes, including preterm birth and maternal mortality.
The U.S. already has one of the highest maternal mortality rates in the industrialized world. In 2020, roughly 900 women died from pregnancy-related causes, many of which were deemed preventable. Maternal mortality rates among Black and Native American women are two to three times higher than those of their white counterparts, reflecting systemic inequities in access to care and resources.
The Impact of Limited Maternity Services
Hospital closures and reductions in obstetric services, particularly in rural areas, have worsened the problem. Financial constraints often lead to the elimination of maternity wards, forcing pregnant individuals to travel long distances for care or forego it altogether. This lack of access has contributed to worsening preterm birth rates, which remain historically high at 10.4%. Black mothers face an even higher preterm birth rate of 14.7%, nearly 1.5 times the national average.
Inadequate prenatal care, another consequence of maternity care deserts, is linked to a 9% increase in preterm birth rates. The March of Dimes reports that 15.7% of pregnant individuals received inadequate prenatal care in 2023, the highest rate in a decade. These disparities are especially pronounced among Black and American Indian/Alaska Native communities.
Chronic health conditions, such as hypertension and diabetes, further complicate the picture. Pre-pregnancy hypertension rose by more than 10% in a single year, increasing the risk of preeclampsia and preterm birth. Environmental factors, such as exposure to extreme heat and air pollution, also play a role. Nearly 40% of pregnant individuals are at risk of extreme heat exposure, and three in four face poor air quality, both of which are linked to preterm births, low birth weights, and stillbirths.
The Role of Abortion Restrictions
The post-Roe v. Wade landscape has made things even more complicated. Strict abortion laws are discouraging obstetricians from working in states with tough regulations, which means fewer maternity care providers where they’re needed most. This shortage only adds to the struggles pregnant people already face in areas with limited or no access to care.
Potential Solutions
While telehealth services offer a glimmer of hope for prenatal and postpartum care, they are not a comprehensive solution. Giving birth requires in-person care, and reliable internet access, often lacking in rural areas, is essential for telehealth to be effective. Addressing maternity care deserts requires systemic changes, including:
Investments in rural healthcare infrastructure to reopen or maintain obstetric services.
Expansion of Medicaid coverage to ensure low-income families can access maternity care.
Targeted interventions to address racial and geographic disparities in maternal and infant health outcomes.
Support for maternal healthcare providers, such as loan forgiveness programs, to attract and retain talent in underserved areas.
The March of Dimes’ 2024 Report Card highlights the urgency of addressing maternity care deserts. Without meaningful action, the U.S. risks worsening outcomes for mothers and babies, further entrenching health inequities in vulnerable communities.
