Millions of Women Live in ‘Maternity Care Deserts’: Report

Across the United States, nearly 6 million women live in areas with little to no access to maternity care options, according to a recently released report by March of Dimes. The lack of options can affect close to 350,000 births.

The report also shows that there has been a 4% drop in the number of birthing centers across the country since 2018. This has left a staggering 369 counties — roughly one-third of all counties in the country — with limited, or in some cases, no access to maternity care.

These counties, largely located in the rural Midwest and the South, are dubbed maternity care deserts by the report. These areas are “without a hospital or birth center offering obstetric care and without any obstetric providers” such as OB-GYNs, nurses and midwives.”

In other words, people living in these places have extremely limited access to professional reproductive care for the mother and fetus. This includes preventative care, prenatal care during pregnancy, labor and delivery and postpartum care post-delivery. 

Providing Care in a Maternity Care Desert

ViviAnne Fischer, CNM, a licensed midwife who heads the Nest Birth and Wellness birthing center in Pullman, Washington, is all too familiar with maternity care deserts. 

Midwives or certified nurse-midwives are licensed healthcare specialists who assist women through low-risk cases of pregnancy and childbirth. They can work in tandem with OB-GYNs and may focus on home births or work in other non-hospital settings. In 2021, midwives attended just 12% of births in the U.S., though overseas, midwifery services tend to be more popular. 

Fischer provides midwifery services to people in rural locations -— many of whom live in areas with very little access to reproductive care. She regularly works in Latah and neighboring Nez Perce Counties in Idaho — an area that includes nearly 2,000 square miles. To put it another way, driving between the two counties could easily take up to an hour, depending on where you’re going. 

“Ideally, I don’t like to provide services without a hospital in a 30-minute radius. Even then, I get nervous,” Fischer tells The Messenger. “In certain scenarios, especially if [a client has] moved and there are no services available to them nearby, I have driven two and a half hours to deliver a baby.”

With nowhere to go, the women are often forced to seek alternative options such as home births or opt for community births. 

If there’s a medical emergency, without timely medical help, serious complications can arise for both the mother and baby. 

Fischer says one of the biggest complications she closely watches for is postpartum hemorrhage (PPH). It’s a serious yet rare condition that causes heavy bleeding right after birth. Up to 5% of people experience PPH. 

Treatment requires a medical professional to stop the bleeding at the source and provide a blood transfusion within five minutes, without which the outcome might be grim. PPH is tied to about 12% of maternal deaths in the U.S. 

“We do carry medications, IV fluids and other necessary supplies in case of an emergency,” Fischer notes. 

But in certain home birth cases located more than 30 minutes from the nearest hospital, Fischer coordinates with the local medevac transport and has them on standby to airlift patients to the nearest hospital.

“We have all that in place beforehand in case of an emergency,” Fischer adds. 

A Disproportionate Problem

Maternity care deserts disproportionately affect women of color. Per the report data, in 2020, one in four Native American babies and one in six Black babies were born in areas with limited or no access to maternity care. 

And the onset of the COVID-19 pandemic only amplified the problems.  

According to the report, between 2020 and 2022, while 94 counties across the U.S. increased access to maternal care, 153 counties saw a decline. In 56 counties, there was a reduction in the number of OB-GYNs; while in 37 counties, the number of hospitals decreased; and in 20 counties, the lack of access was due to a combination of the two issues. 

The report attributes the dwindling number of hospitals, birthing centers and maternity unit closures in most of rural America to the business models, staff burnout and recruitment issues. 

According to the American Hospital Association, more than half of the births in maternity care deserts are reimbursed by Medicaid. And the rates of this government-subsidized program for people with low income are much lower than private insurance. On average, research shows hospitals tend to spend more money on people with Medicaid. 

To put that in perspective, a report by The Commonwealth Fund shows that in 2020, hospitals received only 88 cents for every dollar spent on patients with Medicaid. This often forces hospitals to make staffing cuts, reduce pay or worse, close certain units or the entire hospital altogether. 

To add to this, the American College of Obstetricians and Gynecologists estimates that 40% to 75% of OB-GYNs experience some form of burnout. This may have to do with the demanding pace of work, stress and increasing patient load, all of which make it difficult for hospitals to recruit and retain doctors, further restricting care. 

Among the states with the highest rates of maternity care deserts were North Dakota, South Dakota, Alaska, Oklahoma and Nebraska. 

“Every baby deserves the healthiest start to life, and every family should expect equitable, available, quality maternal care,” Elizabeth Cherot, M.D., president and CEO at March of Dimes, said in a statement.  

“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,” Dr. Cherot explained.