America’s Maternity Care Desert Crisis

An Overview

The United States has some of the most advanced medical technology in the world. And yet, for millions of women, maternity care is still out of reach. Over 2 million women ages 15 to 49 live in places where they can’t access even the most basic obstetric services, and each year at least 150,000 babies are born in these areas. For women in rural counties, going to a prenatal appointment can be a full-day ordeal, spending hours commuting to and from clinics, wondering what would happen if labor started on the way. This has been their reality for decades.

Definition

When you hear the word “desert,” you probably picture miles of sand, empty roads, and a whole lot of nothing. But a maternity care desert looks nothing like that. Instead of a void, it’s full of women who are trying to have healthy pregnancies and safe births. But there are no hospitals that deliver babies, no OB-GYNs, no midwives, travel times of 30 to 60 minutes and more obstacles. If something goes wrong, there may be no reliable way to get emergency care in time.

Data, illustrated by the 2024 March of Dimes map above, show just how widespread the deserts have become. They are concentrated across the rural South, Midwest, and interior West, with the deepest gaps in the Plains and stretching to the rural South, creating belts where women are forced to drive long distances for care. On the other hand, major cities and their surrounding suburbs consistently have far greater access. 

How Did This Happen?

Rural hospitals serve roughly 60 million Americans, yet hospital closures have played a major role in the rise of maternal care deserts. Since 2010, nearly 150 rural hospitals have fully closed, and many others have shut down their obstetric units while keeping other services open. By the early 2020s, over half of rural hospitals no longer offered labor and delivery services, and once those units disappear, they are rarely brought back.

Provider shortages exacerbate the situation. The United States faces a longstanding shortage of OB-GYNs and midwives. Almost half of U.S. counties lack a single OB-GYN, and many have no midwife or birthing facility at all.​ This is not due to a lack of interest. For instance, across the country limited training positions for OB-GYNs turn away 80% of medical students who want to enter the field.

Policy and payment gaps also play a major role. Low Medicaid reimbursement rates and thin operating margins make rural obstetric units financially vulnerable, so they are often the first services cut when hospitals are under pressure. Proposed Medicaid cuts and insufficient investment in rural health infrastructure accelerate these closures.​

Technologies like telehealth can help with prenatal counseling and follow-up care, but they have limits. A video call cannot deliver a baby or manage an emergency during labor. In counties with limited broadband access, even virtual care remains out of reach.

The Road Ahead

To combat maternity care deserts, some efforts focus on bringing care directly to patients through mobile prenatal clinics. Other efforts focus on attracting OB-GYNs and midwives to rural areas through loan-repayment and scholarship programs. Still, the trend is moving in the wrong direction. In 2024, over 35% of U.S. counties were classified as maternity care deserts, and estimates indicate an alarming increase to almost 50% in 2025. It will take a fundamental change in the system to ensure that every woman, no matter where she lives, receives the care she deserves.