Importance of addressing care deserts

The absence of healthcare options in these areas affects not only the physical health of individuals but also the broader public health landscape. With fewer providers available, people are more likely to experience delays in receiving care, which leads to both poorer health outcomes and increased medical costs.

Tackling care deserts is not just an issue of convenience. It’s an issue of equity, quality of life, and long-term sustainability for communities. By addressing these gaps, we can create a healthier, more resilient society for everyone.

Maternity care deserts

Maternity care deserts are areas where it is significantly challenging for pregnant individuals to access prenatal, labor, and postpartum care. The reality is that many people in these areas face the dilemma of either giving birth without essential care or enduring exhausting commutes to access treatment.

A 2024 report from March of Dimes found that nearly 5.3 million women and 350,000 live births across the U.S. are impacted by a lack of maternity care access, with many rural regions —

particularly in the Midwest and South — that have no obstetricians or midwives for miles.

According to Dr. Zsakeba Henderson, senior vice president for March of Dimes, “Many people don't know that we are in a maternal and infant health crisis in [the United States]. Part of that problem is not having access to high-quality maternity care. We have failed moms and babies too long in our country, and we need to act now to improve this crisis.”

Causes of maternity care deserts

• Geographic barriers. In rural areas, hospitals and clinics may be few and far between, requiring people to travel hours for routine checkups or emergencies. March of Dimes’ 2024 report found that two-thirds of maternity care deserts are in rural areas, and people living in these places have to travel 2.8 times longer to reach a birthing hospital than in full access areas.
• Economic factors. The cost of treatment, combined with limited insurance coverage, can push essential care out of reach for many people. March of Dimes found that maternity care deserts have median household incomes below the national average, and that the average percent of uninsured women in these areas is double the rate of those living in areas with full access to maternity care.
• Provider shortages. A lack of obstetricians and midwives, especially in underserved areas, contributes significantly to the shortage of care. According to March of Dimes, over 36% of counties lack an obstetric clinician and 1.2 million women live in counties with only one. Healthcare providers tend to work in areas where they want to live, and this does not translate to an equitable distribution. This problem is compounded by the growing shortage of obstetrician/gynecologists.
• Cultural and linguistic barriers. Some regions struggle with effectively reaching diverse populations, especially those who speak languages other than English. There are also racial and ethnic disparities that exist in our healthcare system as a whole, and are carried over into maternity care deserts. For example, American Indian/Alaska Native birthing people are more likely to live in counties with low or moderate access to maternity care.

Impact on pregnant people and babies

Access to high-quality care before, during, and after pregnancy can prevent most pregnancy-related deaths. The effects of maternity deserts are serious. Delayed maternity care can result in life-threatening consequences for both the parent and child.

Expectant mothers who do not receive prenatal care are three to four times more likely to die from pregnancy complications, and babies are five times more likely to die in infancy. Infants are also three times more likely to have a low birth weight, which increases their risk of other health complications.

People who live in maternity care deserts and low access counties have a higher risk of receiving inadequate prenatal care or none at all, and they also have a higher risk of a preterm birth. Preterm births are associated with long-term health problems, as well as increased medical costs due to longer hospital stays in neonatal intensive care units. These challenges can be emotionally and financially draining for parents, and negatively impact mental health.

Examples of maternity deserts

The March of Dimes provides a detailed breakdown of maternity care desert data for each state, so you can see how your state stacks up. North Dakota, South Dakota, Oklahoma, Missouri, Nebraska, and Arkansas have the highest percentages of maternity care deserts.

For example, in North Dakota, where 71.7% of counties are defined as maternity care deserts, we see the following impacts:

• 43.8% of women have no birthing hospital within 30 minutes
• 13.7% of pregnant individuals receive inadequate prenatal care
• 24.5% of counties have both a high burden of chronic health conditions and a high rate of preterm birth

Solutions and initiatives

The existence of maternity care deserts is a complex problem that requires a multifaceted solution. There are multiple approaches we can take to bridge the gap in maternity care, including:

• Telemedicine and mobile clinics. Virtual consultations with healthcare providers are more prevalent in the post-COVID era, and continued investment in telehealth is vital to enable pregnant individuals to receive care without needing to travel. Mobile clinics can also provide essential prenatal and postnatal treatment to areas lacking maternity care.
• Incentive programs. Financial incentives, loan forgiveness, and housing support can encourage healthcare professionals to practice in underserved regions. March of Dimes also advocates for innovating payment methods for maternity care, and moving towards a value-based model that incentivizes providers to deliver cost-efficient, high-quality, and coordinated care.
• Community-based support. Local initiatives, such as doula programs and maternal health workshops, can help improve birth outcomes by guiding expectant parents through their pregnancy journey and educating them on prenatal care.
• Policy changes. There are multiple areas of policy action defined by the March of Dimes that can help move the needle on improving access to maternity care and counteract the effects of care deserts, including expanding and improving Medicaid to improve insurance coverage and affordability, as well as removing regulatory barriers for birth centers and midwives to increase maternity care availability.

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