Report Shows 4% Drop in Birthing Hospitals with Nearly 6 Million Women Living in Areas with No or Limited Access to Care
Organization’s Landmark Study Gives State-by-State Insights into Key Factors Impacting Healthy Pregnancies and Births
August 1, 2023 (Arlington, VA) – Today, March of Dimes today released Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity, a new collection of reports that shows more than 5.6 million women live in counties with no or limited access to maternity care services, forcing families to find new ways to get the care they need. The new research from March of Dimes shows that for millions of women in the United States, it's more difficult to access maternity care. One of the largest analyses on maternity care access, the reports offers insight into the factors that impact pregnancies in all 50 states, Washington, D.C., and Puerto Rico.
“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 Dr. Elizabeth Cherot, March of Dimes President and Chief Executive Officer. “Our research shows maternity care is simply not a priority in our healthcare 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.”
Since 2018, March of Dimes has explored access to maternity care in America through our maternity care deserts reports. More than one third (36%) of U.S. counties are considered maternity care deserts, which are defined as counties without a hospital or birth center offering obstetric care and without any obstetric providers. March of Dimes is releasing these expanded, state-by-state in-depth reports that examine factors that impact access to care, health outcomes, and unique barriers for all pregnant persons in maternity care deserts. This new data shows increasing areas with less access to care, impacting women before, during and after their pregnancy journey.
The Reports Shows Access To Care Continues to Decline:
- The loss of obstetric units in hospitals was responsible for decreased maternity care access in 369 counties since the 2018 report, nearly 1 in 10 counties across the U.S.
- 70 additional counties have been classified as maternity care deserts due to a loss of obstetric providers and obstetric units in hospitals, since the initial report in 2018.
- More than 32 million reproductive-age women are vulnerable to poor health outcomes due to a lack of access to reproductive healthcare services, like family planning clinics and skilled birth attendants.
- States with the highest rates of maternity care deserts include North Dakota, South Dakota, Alaska, Oklahoma, and Nebraska, states with more rural populations.
These reports come during a critical time for hospitals struggling with maternity unit closures, recruitment, and staffing. Even before the pandemic, hospitals started closing maternity units across the country due to low birth volume and rising costs. According to the American Hospital Association, more than 50% of births in maternity care deserts are reimbursed by Medicaid, which have lower reimbursement rates—forcing hospitals to make cuts that leave patients without access to care. In addition, the American College of Obstetricians and Gynecologists has reported obstetrics to have one of the highest burnout rates across medical specialties, making it difficult to recruit and retain providers.
Beyond Access: Environmental, Socioeconomic and Chronic Health Impact
Beyond hospital closures limiting access to care, environmental factors, socioeconomic issues, and chronic health conditions play a large role in pregnancy and birth outcomes. In fact, violent crime rates, pollution, and housing conditions consistently indicate a higher percentage of inadequate prenatal care, especially for women of color. Socioeconomic factors including educational attainment, social support, poverty, and food security also consistently lead to higher rates of inadequate prenatal care in high-risk communities.
Furthermore, 8 out of 10 maternity care deserts have a high burden of pregnant persons with pre-existing chronic health conditions, which can increase the risk for conditions like preeclampsia and preterm birth. Chronic conditions, like hypertension, diabetes, weight (being under or overweight), and smoking are known to impact underserved populations, at a higher rate—placing a higher burden of care for women living in communities lacking access to trained providers and well-equipped facilities.
“Every baby deserves the healthiest start to life, and every family should expect equitable, available, quality maternal care,” Cherot added. “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—the first step in our work to put solutions in place, and build a better future for all families.”
The Opportunity for Change
March of Dimes published these reports to raise greater public awareness of the barriers to access maternity care and the action needed to drive change. March of Dimes supports priority legislation, programs, and funding that sustain and expand telehealth programs for both consumers and providers, state perinatal regionalization programs that expand access to appropriate levels of care, and healthcare workforce programs that support the expansion of healthcare personnel in rural and underserved communities. March of Dimes supports the expansion of the Rural Maternity and Obstetrics Management Strategies (RMOMS) and Rural Obstetrics Access and Maternal Services (ROAMS) programs to all states. The organization continues to advocate that all states extend Medicaid postpartum coverage from 60 days to a full year. These identified policy and programmatic opportunities can begin to address the limited access to maternity care in the U.S. and provide more options for healthcare delivery.
Additionally, the organization is funding Prematurity Research Centers (PRCs) and continuing to invest in early-stage companies through March of Dimes’ Innovation Fund, in an effort to help address the most pressing maternal and infant health challenges. In its first year, the Innovation Fund has added three key investments to its portfolio and will continue to invest in additional Maternal and Infant Health (MIH) ventures aligned to March of Dimes strategic focus areas. Lastly, March of Dimes provides access to resources, knowledge, support, and services before, during, and after pregnancy in both English and Spanish via marchofdimes.org and nacersano.marchofdimes.org.
It Will Take All of Us
Maternal health impacts all of us, and March of Dimes believes we all have a role to play when it comes to fighting for the health of moms and babies.
Visit www.marchofdimes.org/mcdr to learn about the reports, stay updated on local initiatives, and find out how you can improve maternal and infant health outcomes.
About March of Dimes
March of Dimes leads the fight for the health of all moms and babies. We support research, lead programs, and provide education and advocacy so that every family can have the best possible start. Building on a successful 85-year legacy, we support every pregnant person and every family. To learn more, please visit marchofdimes.org.