Maternity care 'deserts' common throughout America, report finds

More U.S. women are living in areas with little or no maternity care, raising concern about their ability to have a healthy pregnancy and birth.

New research from the March of Dimes shows a 4% drop in birthing hospitals throughout the United States and Puerto Rico, and decreased access to maternity care in 369 counties since 2018.

More than 32 million women lack access to reproductive health care services, including family planning clinics and skilled birth attendants.

More than 5.6 million live in counties with little or no access to maternity care services.

These maternity care "deserts" leave them vulnerable to poor health outcomes.

"A person's ability to have a healthy pregnancy and healthy birth should not be dictated by where they live and their ability to access consistent, quality care but these reports show that, today, these factors make it dangerous to be pregnant and give birth for millions of women in the United States," said Dr. Elizabeth Cherot, president and chief executive officer of the March of Dimes.

"Our research shows maternity care is simply not a priority in our health care system and steps must be taken to ensure all moms receive the care they need and deserve to have healthy pregnancies and strong babies," she added in a March of Dimes news release. "We hope the knowledge provided in these reports will serve as a catalyst for action to tackle this growing crisis."

Since the March of Dimes' 2018 report (before the COVID-19 pandemic), 70 more counties were classified as maternity care deserts due to a loss of providers and obstetric units in hospitals.

The new report looked at each state, as well as Washington, D.C., and Puerto Rico. States with the highest rates of maternity care deserts were the Dakotas, Alaska, Oklahoma and Nebraska.

Hospitals were closing maternity units even before the pandemic because of rising costs and low birth volume, the report noted.

Among other contributors, obstetrics is a medical field with a high burnout rate, according to the American College of Obstetricians and Gynecologists. In addition, more than 50% of births in maternity care deserts are covered by Medicaid, which provides lower reimbursement rates, according to the American Hospital Association.

Environmental and economic factors, as well as chronic health conditions also factor in. The report finds that violent crime rates, pollution and housing conditions consistently indicate a higher percentage of inadequate prenatal care. This is especially true for women of color.

Other societal factors that appear to have an impact on prenatal care in high-risk communities include educational attainment, social support, poverty and food security.

About 8 of 10 maternity care deserts have a high burden of pre-existing chronic health conditions in pregnant women, including high blood pressure, diabetes, weight and smoking that can affect birth outcomes, according to the report.

"Every baby deserves the healthiest start to life, and every family should expect equitable, available, quality maternal care," Cherot said. "These new reports show that the system is failing families today but paints a clear picture of the unique challenges facing mothers and babies at the local level—the first step in our work to put solutions in place, and build a better future for all families."

The report—"Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity"—is meant to raise awareness about these issues and drive change.

Among other initiatives, the March of Dimes supports legislation, programs and funding to sustain and expand telehealth programs for maternity care, state efforts to expand access to care, as well as workforce programs that support expanding health care personnel in rural and underserved communities.

The March of Dimes also supports all states extending Medicaid's postpartum coverage from 60 days to a full year. The organization is funding a number of initiatives aimed at addressing the shortages.

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