Over a 3rd of US counties are 'maternity care deserts,' March of Dimes study finds

Facility closures and limited obstetrics providers are leaving more women of childbearing age and their babies without nearby maternity services, according to a new report from March of Dimes.

Thirty-six percent of U.S. counties had no hospital or birth center offering obstetrics care or any other obstetrics providers in 2020, representing a 2% increase in “maternity care deserts” from a similar report published two years prior, the group found.

These maternity care deserts are home to more than 2.2 million women of childbearing age and saw over 146,000 births, according to census data cited by March of Dimes.

Another 12% of counties have one or fewer facilities providing obstetric care, few obstetric providers or more than 10% of non-senior adult women without health insurance, according to the latest report. These “low access” counties contain more than 3 million women and represent nearly 198,000 births.

“Our 2022 report confirms lack of access to care is one of the biggest barriers to safe, healthy pregnancies and is especially impacting rural areas and communities of color where families face economic strains in finding care,” said Zsakeba Henderson, M.D., senior vice president and interim chief medical and health officer at March of Dimes, in a statement.

“While we’ve seen a slight increase in obstetric providers nationwide, we continue seeing a troubling decrease in providers serving rural areas. In fact, only 7% of obstetric providers serve rural areas and, with more than 500,000 babies born to women living in these areas, families in rural areas are at higher risk for poor outcomes,” she said.

The organization noted that 61.5% of maternity care deserts are in rural counties. Additionally, 90.1% of women in maternity care deserts live in households below the national median income, as opposed to 45.2% of women in “full access counties,” according to the report.

Compared to the 2020 report, 153 (5%) of counties and 94 (3%) of counties saw their access to maternity care decrease and increase, respectively.

Changes in the number of local providers since the 2020 report drove a decline in maternity access in 56 counties while 55 counties saw an increase in care access. Access to hospitals, where over 98% of live births occur, declined among 47 counties due to shutdowns or limited obstetric services, but only increased in eight counties.

March of Dimes highlighted several policy proposals addressing maternity care access, such as expanded Medicaid eligibility, longer duration of postpartum Medicaid coverage, telehealth reimbursement and broader support of midwifery care models and doula support.

“Although some temporary gains in access to healthcare were seen through the Public Health Emergency executive orders, we hope lessons are learned for long-term solutions. We must continue to work to amend the obvious disparities in care experienced throughout the U.S.,” the organization wrote in the report.

March of Dimes built its latest report using a combination of 2019, 2020 and 2021 data from government and national healthcare organization sources such as the National Center for Health Statistics (NCHS) and the American Hospital Association’s annual survey.

Even prior to the onset of the pandemic, analyses showed maternal mortality rates in the U.S. far outstripped those of other wealthy and developed nations.

The numbers only got worse with a 14% increase from 2019 to 2020, according to NCHS data reported earlier this year. These rates included a significant disparity in death rates among non-Hispanic Black women (55.3 deaths per 100,000 live births) compared to non-Hispanic white women (19.1 per 100,000) and Hispanic women (18.2 per 100,000).

Healthcare provider groups, advocates and the federal government have also warned that U.S. maternal care is likely to face a setback this year with the Supreme Court’s repeal of Roe v. Wade and constitutional abortion protections.