Millions of US women don’t have access to maternity care, report warns

More than a third of US counties do not have a single medical birthing facility or the services of an obstetric clinician, causing health advocates to warn about the dangers of “maternity care deserts”, a new report says.
The report, issued by March of Dimes, an infant health non-profit, and published on Tuesday, found that 35.1% of US counties are what the group calls maternity care deserts, meaning there are no specialist medical services available to provide care.
These 1,104 counties are home to more than 2.3 million women of reproductive age, the report states, and in these counties in 2022, women gave birth to more than 150,000 babies.
The report says that women living in such care deserts and counties with low access to care are more likely to have poorer health before pregnancy, receive less prenatal care, and experience higher rates of preterm birth. Additionally, the researchers state that women in these areas face a 13% higher risk of preterm birth.
The states with the highest percent of so-called maternity care deserts were North Dakota, South Dakota, Oklahoma, Missouri, Nebraska and Arkansas, it added.
The researchers found that around six in 10 maternity care deserts were in rural areas, and nearly 70% of birth centers were in just 10 states.
In recent years, the report says that there has been a rise in hospital obstetric unit closures in the US and more than half of US counties have no hospital that provides obstetric care.
Since 2022, more than 100 counties have seen a decline in maternity care facilities, and according to the report, one in every 25 obstetric units has closed, leading to fewer choices for families, “increased stress, and greater travel times for birthing people”, the report reads.
In a news release after the report was published, March of Dimes’s chief medical officer, Dr Amanda Williams, called for systemic change and said that for too many US families, “the ability to have a healthy pregnancy depends on where they live” and “maternity care is still not prioritized in our country”.
The report states that the reversal of Roe v Wade by the US supreme court in 2022, as well as low health insurance reimbursement rates and payment structures have contributed to hospital closures and the decline in the OB-GYN workforce.
The report mentions that the reversal of Roe continues to impact how and where OB-GYNs train and deliver care.
In states with severe abortion restrictions, some doctors have left due to the threat of severe consequences and punishment for providing abortions. These states have also experienced notable decreases in applications for obstetric residencies, partly because of the inability to provide training in abortion care, the report added.
The report did say that the US experienced an increase in the use of birth centers from 2017 to 2022. Birth centers, according to the American Association of Birth Centers, are healthcare facilities where care is provided in the midwifery and wellness model but are not hospitals.
Kali Bautista, a resident of Brownfield, Texas, told the researchers that one of her biggest fears while pregnant was delivering on the way to her nearest birthing hospital, 45 minutes away. Instead, she said, she opted to receive care at a birthing center.
But, the report noted that there were still only 417 licensed birth centers across 270 counties and less than 5% were in rural areas.
In August, a report published by the US Center of Disease Control found that fewer women received early and adequate prenatal care in 2023 than the year before, representing the second such decline in two years.