Care deserts: What they are and how to address them

In care deserts, whether urban or rural, people may find it challenging or even impossible to receive the care they need when they need it. These areas represent critical gaps in our healthcare system that can have far-reaching consequences for public health, individual well-being, and economic stability. 

This article will explore three major types of care deserts that each have a unique set of challenges and solutions: 

1. Maternity care deserts
2. Fertility deserts
3. Pharmacy deserts

What is a care desert?

Any area where access to basic healthcare treatment is severely limited or nonexistent can be referred to as a “care desert.” For example, in the United States, over 35% of counties are considered maternity care deserts and 46% of counties are considered pharmacy deserts. 

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.

Fertility deserts

A fertility desert refers to an area where there is a lack of access to fertility clinics and assisted reproductive technology such as in vitro fertilization (IVF). Fertility treatment can be costly and is not commonly covered by insurance, which means living in a region without access to basic fertility care makes it even more challenging to have a child.

Experts agree there is a concerning mismatch between the demand for fertility care and the supply of care providers in the United States. In 2019, there were only 448 fertility clinics staffed by 1,351 trained reproductive endocrinologists. Meanwhile, there are approximately 12.2 million people experiencing fertility challenges who would benefit from care.

There are multiple reasons demand for fertility care is increasing, and why addressing fertility care deserts is imperative:

1. The average age of a person’s first childbirth experience continues to rise and is the oldest it’s ever been at 27.5.
2. There’s a worldwide decline in sperm quality, resulting in more male factor infertility.
3. Employers are expanding insurance coverage and offering fertility benefit options like Carrot to keep their compensation packages competitive.
4. People pursuing single parenthood and folks in the LGBTQ+ community want additional family-building options besides adoption.
5. Awareness and interest in fertility preservation, such as egg freezing, is growing.

Causes of fertility deserts

• Geographic limitations. The vast majority of fertility clinics are concentrated in metropolitan areas like New York, Atlanta, or Seattle, leaving rural and remote locations underserved. 
• High costs and limited insurance coverage. Fertility care like IVF is notoriously expensive, which is also a contributing factor to the geographic distribution of clinics around metro areas with higher median incomes. Additionally, many traditional health insurance plans do not offer adequate coverage and put the financial burden of family building on individuals. 
• Stigma and lack of awareness. In some communities, there remains a stigma surrounding infertility, and a lack of awareness about fertility treatments further isolates those in need.

Impact on individuals and families

Having a child is a major milestone in a human life, and while the family-building journey looks different for everyone, the current state of fertility care in the United States means not everyone gets to experience that milestone even if they want to. The impact of fertility deserts and a lack of access to fertility care can lead to:

• Emotional and psychological stress. Fertility challenges alone have a demonstrated impact on mental health. The inability to access fertility treatments on top of that only adds additional frustration, anxiety, and even depression for individuals and couples hoping to get pregnant.
• Financial strain. Fertility care is expensive. The cost of the fertility treatments themselves is already high, so if people are also forced to seek treatment in distant locations or travel for multiple consultations, the financial strain can be overwhelming.
• Delaying or forgoing family building. Couples may delay or abandon fertility treatments due to logistical or financial barriers to access. People who live in fertility deserts and do not have sufficient financial resources may be forced to forgo having a child entirely.

Examples of fertility deserts

Fertility care is overwhelmingly concentrated in urban and suburban areas, and nearby geographic access to assisted reproductive technology clinics is limited or nonexistent for 25 million reproductive-age women in the United States. 

Solutions and initiatives

To solve the challenge of fertility deserts and improve access to family-building care, there are multiple geographic, financial, and social barriers that need to be addressed. Some potential initiatives include:

• Telehealth service expansion. Telehealth can help bridge the geographic gap in fertility care by offering remote consultations with specialists. This reduces the need for travel, enhances accessibility, and provides ongoing support to make fertility care more affordable and convenient. 
• Financial assistance programs. Financial assistance and sliding scale fees can help reduce the cost burden of fertility treatments, particularly in underserved areas. These programs, supported by partnerships with clinics, non-profits, and employers, can offer subsidized treatments or grants to ensure financial barriers do not prevent access to care.
• Increased numbers of fertility specialists. To address fertility deserts, increasing the number of specialists in underserved regions is crucial. Incentives such as loan forgiveness or clinic subsidies can attract professionals to rural areas.
• Public awareness campaigns. Public awareness campaigns can reduce the stigma surrounding infertility and educate individuals on available fertility options. By dispelling infertility myths and promoting accurate information, these initiatives can encourage people to seek care and drive demand for expanded fertility treatment.

Pharmacy deserts

Pharmacy deserts occur when residents of a community lack access to nearby pharmacies and have difficulty obtaining prescription medications or over-the-counter essentials. These deserts, spanning both urban and rural areas, contribute to a range of negative health outcomes, from low medication adherence to increased hospitalizations.

In the United States, 15.8 million people live in areas that are considered pharmacy deserts, where they may have to travel long distances to pick up prescriptions or get basic pharmaceutical advice. Pharmacies also provide other valuable healthcare options, such as routine vaccination and contraception, that are vital to community health.

Causes of pharmacy deserts

• Urban and rural disparities. In rural areas, low population density makes it financially challenging for pharmacies to operate. In urban low-income neighborhoods, pharmacy closures are often driven by low profit margins. Both scenarios further reduce healthcare access in already marginalized communities.
• Economic factors. Rising operating costs and shrinking profitability have led to widespread pharmacy closures, particularly in underserved areas. People have been left without convenient options to fill prescriptions or access health treatment.
• Transportation barriers. Many people who live in pharmacy deserts find it inconvenient or difficult to travel to distant pharmacies due to a lack of personal transportation or inadequate public transit. This is especially challenging for people with disabilities or advanced age who may rely on medication access to maintain their quality of life.
• Regulatory issues. State and local regulations plus licensing requirements can prevent new pharmacies from opening or expanding certain services. Adopting less restrictive policies through legislation or regulation can reduce the prevalence of pharmacy deserts.

Impact on community health

Pharmacy deserts make obtaining prescription medications more difficult and force individuals to travel long distances, which often leads to missed doses or a lack of treatment entirely. This disruption not only impacts short-term health but can result in long-term complications and worsened outcomes, especially for those with chronic conditions. 

Preventable complications due to medication non-adherence also increase hospitalizations and drive up emergency care costs. Additionally, the lack of nearby pharmacies to address basic health needs drives many to rely on emergency services for non-urgent issues, which places unnecessary strain on the healthcare system. 

Vulnerable populations such as people with low income or Black, Indigenous, and Latin communities are disproportionately affected by pharmacy deserts. This only deepens health disparities and contributes to broader inequalities in healthcare access and quality.

Examples of pharmacy deserts

Rural pharmacy desert example

In Antwerp, Ohio, the closure of the town's only pharmacy in September 2024 left the small rural community of 1,600 residents without local access to medications. Candace Pidgeon, a former pharmacy tech, lost her job as the independent pharmacy closed due to financial pressures from larger chain pharmacies. Now, Pidgeon must drive 22 miles to the nearest CVS for her prescriptions as she is unable to use a closer locally-owned pharmacy due to insurance restrictions.

Urban pharmacy desert example

In Roxbury, a predominantly Black and Latin neighborhood in Boston, Massachusetts, four Walgreens have closed since 2017. Donna Adams, a resident of Roxbury in her 70s, has faced increasing difficulty accessing her medications since the closure of the Walgreens near her apartment in 2022. Initially able to reach the pharmacy with just her electric wheelchair, she then had to switch to a pharmacy a one mile bus ride away until that location closed too. Adams now takes the bus for up to 20 minutes to a more distant Walgreens, which is both uncomfortable and inconvenient. 

An analysis from The Boston Globe found that nearly 15,000 people in Boston live in pharmacy deserts. Other neighborhoods with similar demographics to Roxbury like East Boston and Dorchester, and diverse communities outside the city, are likewise underserved. As Bisola Ojikutu, executive director of the Boston Public Health Commission says, “These [pharmacy] closures are reinforcing systemic inequities and long histories of structural racism. It’s a significant concern for the city and the health of our people.”

Solutions and initiatives

To address pharmacy deserts and ensure all communities have access to essential medications and healthcare, there are several solutions that have the potential to make a meaningful impact:

• Mobile pharmacies and delivery services. Mobile pharmacies and prescription delivery services can bring medications directly to underserved areas and eliminate travel headaches for folks with limited mobility or transportation options.
• Incentives for opening pharmacies. Financial incentives, such as grants, tax benefits, or even increased Medicaid reimbursement could encourage pharmacies to establish locations in underserved communities and help improve access.
• Partnerships. Collaborations between pharmacies, local organizations, and health systems can help bring essential medications and pharmaceutical care to communities.
• Technology and telepharmacy. Leveraging technology, including telepharmacy and prescription management platforms, can enable remote consultations and streamline medication refills. 

Comparative analysis of care deserts

Common factors across all care deserts

Although maternity, fertility, and pharmacy deserts all have distinct characteristics, they also share four common factors that consistently contribute to healthcare inequity across regions and reduce the accessibility of essential care:

1. Geographic isolation. Whether in rural, remote, or economically disadvantaged urban areas, care deserts force people to travel taxing distances to reach a provider and receive the specialized care they need.
2. Economic barriers. Rising care costs and limited insurance coverage create financial barriers that exacerbate healthcare access issues in all care deserts. This is compounded by income inequality across underserved regions. 
3. Provider shortages. A lack of specialists, staff, and service locations limits access to essential health treatment in all care deserts. These shortages are driven by factors like low wages, high burnout, and insufficient incentives to practice in underserved areas.
4. Social and cultural challenges. Language barriers, stigma, lack of awareness, mistrust of the healthcare system, diversity in cultural norms, and racial disparities are challenges found throughout care deserts, regardless of type. 

Unique challenges for each type of care desert

Maternity care deserts 

These are among the most researched and documented types of care deserts. Maternity care is deeply embedded in traditional healthcare and insurance systems, which presents both advantages and challenges. The good news is there are clear, actionable steps to take within existing frameworks to improve access and outcomes for parents and children. However, the complexity lies in the wide range of issues that need to be addressed, including increasing the availability of obstetricians and midwives, expanding prenatal education, and incentivizing birth centers in underserved areas, among other things.

Fertility care deserts 

Fertility care deserts emerged because the fertility industry was initially viewed as an elective service for wealthy individuals, and clinic distribution reflected that focus. However, as demand increases and the importance of fertility and family-building care for overall health outcomes becomes more widely recognized, there is a growing need for a more equitable geographic distribution of fertility clinics and more financially accessible solutions.

Pharmacy deserts

Pharmacy deserts operate at a crucial intersection of business and healthcare, and the failure of these systems to align often leads to the creation of pharmacy deserts. Vulnerable populations bear the greatest consequences and lose vital access to healthcare options, a challenge felt in both urban and rural areas. The issues that need to be addressed are complex, ranging from inflexible insurance coverage and shareholder-driven priorities of large pharmacy chains to the difficulty small pharmacies face in negotiating drug prices. 

Interconnectedness of care deserts

Care deserts rarely exist in isolation. People living in these underserved areas face compounded barriers that extend across multiple areas of their healthcare needs. 

For example, a pharmacy desert can directly affect maternity care by making it harder for expectant mothers to access essential prenatal vitamins or medications for pregnancy complications. 

Similarly, in fertility deserts, the lack of fertility specialists can delay infertility diagnosis and treatment. People struggling to get pregnant may experience emotional distress or have trouble managing chronic health issues that affect reproductive health, especially if their access to maternity care or a pharmacy is also limited. 

Strategies for combating care deserts

Policy and advocacy

To combat care deserts, there must be strong government support for funding and expanding healthcare access in underserved regions. This can include grants for healthcare facilities to open in rural areas, subsidies for providers to work in these regions, and funding for mobile health clinics that can bring care directly to communities. Additionally, tax incentives for private practices to open in underserved areas or public-private partnerships can help establish a healthcare infrastructure where it's most needed.

Another key area is advocating for insurance reforms that would broaden coverage while also minimizing the financial burden on individuals. Insurance providers must be encouraged to offer better coverage for care that is typically excluded, such as fertility treatments, and expand access to affordable prescriptions for people with chronic conditions, as well as provide flexibility in where they can purchase those medications.

Technological innovations

Telehealth is an excellent tool for overcoming the geographic barriers inherent in care deserts. For maternity care, virtual prenatal consultations can provide patients with early screenings, advice, and regular monitoring without the need to travel. Telepharmacy can make medication management more accessible in pharmacy deserts by enabling consultations and prescription refills remotely.

In fertility deserts, online consultations and referrals can allow individuals to access fertility care from the comfort of their own home, and companies are continuing to innovate in technology for improving remote care. For example, Carrot is expanding our telemedicine offerings to include virtual menopause support, which includes access to prescriptions through Carrot Rx if needed, and solves some of the geographic challenges of both fertility and pharmacy deserts.

Community engagement and support

Local healthcare providers, community organizations, and social service agencies should collaborate to provide more integrated care solutions. Community health worker programs, for example, can act as a bridge to educate residents about available treatment options and help them navigate the healthcare system. Local organizations can also help organize transportation for individuals who need to travel for care.

Many individuals in care deserts are unaware of the healthcare options available to them or are hesitant to seek care due to cultural stigma. Outreach programs can provide critical education, build trust, and empower individuals to access the care they need. Educational campaigns around maternal health, reproductive rights, and chronic disease management can raise awareness and reduce stigma.

Workforce development

A key challenge in care deserts is the shortage of qualified healthcare providers. To address this, there needs to be an expansion of training programs for obstetricians, fertility specialists, and pharmacists, with incentives for them to work in underserved areas. Scholarships, loan forgiveness programs, and tax incentives can encourage healthcare professionals to serve communities in need.

Providing expanded educational opportunities — particularly for local residents who are interested in healthcare careers — can help to create a sustainable workforce. Community-based training programs in nursing, pharmacy, and maternal health can not only increase the number of available providers but also improve the cultural competency and relevance of care.

Addressing care deserts is crucial for ensuring equitable healthcare access for all. By focusing on innovative solutions that expand availability, increase affordability, and foster inclusivity, we can create a more effective healthcare system.