Maternity care access continues to decline, study finds

A new analysis from the March of Dimes found more than 5.6 million women in the United States live in counties with limited to no access to maternity care services.

It has become increasingly difficult for millions of women across the U.S. to access maternity care, according to a new report from the March of Dimes, which found a five percent increase in counties with less maternity access than just two years ago. The report also revealed a two percent increase in counties that are maternity care deserts (which researchers define as any county without a hospital or birth center offering obstetric care and without any obstetric provider) in the last two years, leading to an additional 1,119 counties and 15,933 women without any maternity care.

Maternity care deserts lead to a higher risk for poor maternal and infant health outcomes. And, according to the report, in the U.S., an average of two women die every day due to complications of pregnancy and childbirth and two babies die every hour.

The 2022 Nowhere to Go: Maternity Care Deserts Across the U.S. report, which is an update to the 2020 report, examines the different factors affecting maternity care access across all 50 states, Washington, D.C., and Puerto Rico in hopes of increasing education and awareness around the growing problem.

"A person's ability to have a healthy pregnancy and healthy birth should not be dictated by where they live and their ability to access consistent, quality care but these reports shows that, today, these factors make it dangerous to be pregnant and give birth for millions of women in the United States," said March of Dimes President and Chief Executive Officer Dr. Elizabeth Cherot in a statement. "Our research shows maternity care is simply not a priority in our health care system and steps must be taken to ensure all moms receive the care they need and deserve to have healthy pregnancies and strong babies. We hope the knowledge provided in these reports will serve as a catalyst for action to tackle this growing crisis."   

The report also found that:

• Thirty-six percent of all U.S. counties are considered maternity care deserts, and the majority (61.5 percent) are in rural counties.
• More than 500,000 babies were born to women who live in rural counties, though only seven percent of obstetric providers practice in rural counties.
• Counties with low access to telehealth were also 30 percent more likely to be maternity care deserts.
• The states with the highest rates of maternity care deserts include North Dakota, South Dakota, Alaska, Oklahoma, and Nebraska.
• More than 2.2 million women of childbearing age live in maternity care deserts, and 4.7 million women live in counties with limited access to maternity care.

• The proportion of women living in counties below the national median household income is twice as high in maternity care deserts (90.1 percent) compared to counties with full access (45.2 percent).
• Nearly half (48 percent) of the counties with full access to maternity care have a high proportion of women (10 percent or more) without health insurance. Two-thirds of maternity care deserts have a high proportion of uninsured women.
• Women living in maternity care deserts are more likely to smoke and have asthma and hypertension compared to women living in counties with full access to maternity care.
• One in four Native American women and one in five Black women did not receive adequate prenatal care in 2020, compared to one in 10 white women. Hispanic and Asian and Pacific Islander women were also less likely to receive adequate prenatal care when compared to white women.

“In order to fight for the health of all moms and babies, we as a country need to invest in policy reform to improve access to high quality maternity care,” wrote researchers, urging for nationwide investments in policy reform to improve access to high quality maternity care.