The Phenomenon of Maternity Care Deserts: Causes, Solutions, and Paths to Progress
As of March 24, 2025, the term maternity care deserts has become a stark shorthand for a growing crisis in maternal healthcare. These are regions—often entire counties—where access to obstetric care is scarce or entirely absent, leaving pregnant individuals without nearby hospitals, birth centers, or providers like OB-GYNs and midwives. This phenomenon, spotlighted by groups like the March of Dimes, affects millions, particularly in rural and underserved urban areas. But what’s driving this alarming trend? And more importantly, how can it be addressed? Below, we explore the causes, potential solutions, and actionable steps to fix this pressing problem.
The Causes: Why Are Maternity Care Deserts Spreading?
The rise of maternity care deserts is a complex tangle of economic, systemic, and social factors. Here’s what’s fueling the phenomenon:
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Hospital and Unit Closures
Financial pressures are a primary culprit. Labor and delivery units are expensive to maintain, requiring specialized staff, equipment, and round-the-clock availability. In rural hospitals or smaller urban facilities, low birth volumes and insufficient reimbursement rates—especially from Medicaid, which covers nearly half of U.S. births—make these units unprofitable. Since 2010, hundreds of obstetric units have shuttered, with closures accelerating in recent years as healthcare costs rise and provider shortages deepen. -
Workforce Shortages
There aren’t enough obstetric providers to go around. OB-GYNs and midwives often gravitate toward urban or suburban areas where patient volume justifies their practice. Rural regions struggle to attract and retain these specialists due to lower pay, isolation, and limited resources. Burnout, worsened by the lingering effects of the COVID-19 pandemic, has also pushed providers out of the field entirely. -
Geographic Isolation
In rural America, where over a third of counties are maternity care deserts, sheer distance compounds the problem. Sparse populations mean fewer healthcare facilities, and those that exist may be hours away from residents. Poor infrastructure—think unpaved roads or unreliable public transit—makes travel to care even harder. -
Systemic Inequities
Urban maternity care deserts, while less discussed, are just as real. Hospital closures in low-income neighborhoods, often tied to funding cuts or consolidation by large health systems, leave communities of color disproportionately affected. Structural barriers like poverty, lack of insurance, and distrust in healthcare systems further widen the gap. -
Policy and Reimbursement Gaps
Medicaid reimbursement rates for maternity care are notoriously low, discouraging providers and facilities from serving high-need areas. Meanwhile, the U.S. lacks a cohesive national strategy to ensure equitable access, leaving states and local governments to patchwork solutions—if they act at all.
The Solutions: What Can Be Done?
Addressing maternity care deserts requires a multi-pronged approach, blending immediate fixes with long-term systemic change. Here are some promising solutions:
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Bolster the Workforce
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Incentives for Providers: Loan forgiveness, tax breaks, or higher pay could lure OB-GYNs and midwives to underserved areas. Programs like the National Health Service Corps already do this but need expansion.
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Training Midwives: Certified nurse-midwives and community-based midwives can fill gaps, offering lower-cost, high-quality care. Scaling training programs and easing licensing restrictions could accelerate this shift.
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Leverage Telemedicine
Virtual prenatal and postpartum care can bridge distances, especially for routine checkups. While it can’t replace in-person delivery, telemedicine reduces travel burdens and connects patients to distant specialists. Pairing it with mobile ultrasound units or home-monitoring tools could enhance its impact. -
Support Rural and Community Facilities
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Funding Boosts: Federal and state grants could keep obstetric units open, offsetting losses from low patient volumes. The Rural Maternity and Obstetrics Management Strategies (RMOMS) program is a start but needs more investment.
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Freestanding Birth Centers: These midwife-led facilities offer a cost-effective alternative to hospitals and could thrive in deserts with proper support.
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Improve Transportation
Subsidized ride-share programs, mobile clinics, or community shuttle services could ensure patients reach care. In rural areas, partnerships with nonprofits or local governments could make this scalable. -
Policy Overhauls
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Raise Reimbursement Rates: Increasing Medicaid payments for maternity services would incentivize providers and hospitals to stay in the game.
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Mandate Access: Some advocate for laws requiring a minimum level of obstetric care per region, though enforcement would be tricky.
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How to Fix the Problem: A Roadmap Forward
Fixing maternity care deserts demands action from multiple players—governments, healthcare systems, communities, and advocates. Here’s a practical roadmap:
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Step One: Map the Crisis
Better data is the foundation. Expand real-time tracking of maternity care access (like the March of Dimes’ reports) to pinpoint deserts and prioritize interventions. Engage local communities to identify hidden barriers, like transportation or cultural mistrust. -
Step Two: Invest Now
Immediate funding is critical. Allocate federal dollars to prop up struggling hospitals and launch pilot programs—think mobile clinics in rural Texas or telehealth hubs in urban Chicago. States could tap American Rescue Plan leftovers or push for maternity-specific Medicaid expansions. -
Step Three: Build the Workforce Pipeline
Over the next decade, ramp up training for midwives and rural-focused OB-GYNs. Pair this with retention strategies—housing stipends, mentorship, or flexible schedules—to keep talent in deserts. -
Step Four: Innovate Delivery
Test hybrid models: telehealth for prenatal care, regional birthing hubs for delivery, and community health workers for follow-ups. Evaluate these pilots rigorously to scale what works. -
Step Five: Shift the System
Long-term, overhaul healthcare financing. Tie hospital funding to maternal outcomes, not just profits. Push for a national maternal health strategy that treats access as a right, not a privilege.
The Stakes—and the Hope
Maternity care deserts aren’t just a logistical headache—they’re a life-and-death issue. The U.S. already has the highest maternal mortality rate among wealthy nations, and deserts amplify risks like preterm birth and postpartum hemorrhage. For families, the phenomenon turns pregnancy into a gamble, where zip codes dictate safety.
Yet there’s hope. The fact that this issue is gaining traction—through searches, stories, and advocacy—signals a tipping point. Solutions exist, and momentum is building. By tackling the root causes and committing to bold fixes, society can ensure that no one is left stranded when it’s time to bring new life into the world. The clock’s ticking, but the path forward is clear.
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