With over 3.5 million births in the United States annually, and rising rates of maternal mortality and morbidity, there is ample opportunity to improve maternal outcomes across the country.1 More than 2 million women of childbearing age live in maternity care deserts, areas without access to birthing facilities or maternity care providers. Access to maternity care is essential for preventing poor health outcomes and eliminating health disparities. This report expands on the 2022 Nowhere to Go: Maternity Care Deserts Across the U.S. report2 by taking a deeper dive into state level data and examining additional barriers that impact access to care. This data can be used to inform policies and practice recommendations in each state.
This report presents data on several important factors: levels of maternity care access and maternity care deserts by county; distance to birthing hospitals; availability of family planning services; community level factors associated with prenatal care usage as well as the burden and consequences of chronic health conditions across the state. While not an exhaustive list, each of these topics contribute to the complexity of maternity care access in each state. Working to improve access to maternity care by bringing awareness to maternity care deserts and other factors that limit access is one way in which March of Dimes strives to reduce preventable maternal mortality and morbidity for all pregnant people.
43% increased likelihood of preterm birth compared to women with none.
- Access To Maternity Care
- Distance To Maternity Care
- Availability Of Family Planning Services
- Disparities In Prenatal Care
- Chronic Health Conditions And Preterm Birth
- Policy Solutions And Actions
- Policy Innovation
Families face enough obstacles. Not getting the care they need shouldn’t be one of them. Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity examines access to maternity care in all 50 states, D.C. and Puerto Rico. You can make a difference. Share what is happening in your state on your social channels, by email or by text and encourage others to take action by advocating for change.
This report is generously supported by a grant from the Elevance Health Foundation. Statements in this report are those of the authors and do not necessarily reflect the views of the Elevance Health Foundation or its affiliates unless explicitly noted.
Special thanks to Jazmin Fontenot, MPH; Ripley Lucas, MPH, Ashley Stoneburner, MPH; Christina Brigance, MPH; Erin Jones, JD; Kelly Hubbard, MPH; Motoko Oinuma; Danielle Procopio, MPH; Kelly Ernst, MPH; TiashaLetostak, PhD, MPH; Kathryn Mishkin, DrPH, MPH, MA; Elizabeth Cherot, MD, MBA and many others from across March of Dimes who contributed to this report to improve access to maternity care in the United States. March of Dimes would also like to thank PRI for their help with report design and expertise.
Suggested citation: Fontenot, J, Lucas, R, Stoneburner, A, Brigance, C, Hubbard, K, Jones, E, Mishkin, K. Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity in Texas. March of Dimes. 2023.
- Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final Data for 2020. National Vital Statistics Reports. 2022;70(17). Accessed April 5, 2023. https://www.cdc.gov/nchs/products/index.htm.
- Brigance C, Ripley L, Jones E, et al. Nowhere to Go: Maternity Care Deserts Across the U.S. (Report No. 3). March of Dimes. 2022. Accessed April 5, 2023. https://www.marchofdimes.org/research/maternity-care-deserts-report.aspx
- U.S. Government Accountability Office (GAO). Availability of Hospital-Based Obstetric Care in Rural Areas. October 2022. Accessed April 5, 2023. https://www.gao.gov/assets/gao-23-105515.pdf
- Roa L, Uribe-Leitz T, Fallah PN, et al. Travel Time to Access Obstetric and Neonatal Care in the United States. Obstetrics and Gynecology. 2020;136(3):610-612. doi:10.1097/AOG.0000000000004053
- Minion SC, Krans EE, Brooks MM, Mendez DD, Haggerty CL. Association of Driving Distance to Maternity Hospitals and Maternal and Perinatal Outcomes. Obstetrics and Gynecology. 2022;140(5):812-819. doi:10.1097/AOG.0000000000004960
- Kozhimannil KB, Hung P, Henning-Smith C, Casey MM, Prasad S. Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States. JAMA. 2018;319(12):1239. doi:10.1001/JAMA.2018.1830
- World Health Organization (WHO). Family planning/contraception methods. Published November 9, 2020. Accessed April 9, 2023. https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception
- Kaiser Family Foundation. The U.S. Government and International Family Planning & Reproductive Health Efforts. Published November 11, 2021. Accessed April 3, 2023. https://www.kff.org/global-health-policy/fact-sheet/the-u-s-government-and-international-family-planning-reproductive-health-efforts/
- Napili A. Title X Family Planning Program. Published June 2022. Accessed April 3, 2023. https://crsreports.congress.gov/product/pdf/IF/IF10051#:~:text=What%20Is%20the%20Federal%20Funding,Rescue%20Plan%20Act%20
- Centers for Disease Control and Prevention (CDC). Premature Birth. Published November 1, 2022. Accessed April 3, 2023. https://www.cdc.gov/reproductivehealth/features/premature-birth/index.html
- U.S. Department of Health & Human Services (HHS), Office of Population Affairs. Title X Service Grants. Accessed April 3, 2023. https://opa.hhs.gov/grant-programs/title-x-service-grants
- Valerio VC, Downey J, Sgaier SK, Callaghan WM, Hammer B, Smittenaar P. Black-White Disparities in Maternal Vulnerability and Adverse Pregnancy Outcomes: an Ecological Population Study in the United States, 2014-2018. Accessed April 3, 2023. The Lancet Regional Health. https://www.thelancet.com/journals/lanam/article/PIIS2667-193X%2823%2900030-3/fulltext
- Alexander GR, Kotelchuck M. Assessing the Role and Effectiveness of Prenatal Care: History, Challenges, and Directions for Future Research. Public Health Reports. 2001;116(4):306. doi:10.1016/S0033-3549(04)50052-3
- Hill L, Artiga S, Ranji U. Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them. Kaiser Family Foundation. Published November 1, 2022. Accessed April 3, 2023. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/
- Howell EA. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clin Obstet Gynecol. 2018;61(2):387. doi:10.1097/GRF.0000000000000349
- Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/Ethnic Disparities in Obstetric Outcomes and Care: Prevalence and Determinants. Am J Obstet Gynecol. 2010;202(4):335-343. doi:10.1016/J.AJOG.2009.10.864
- Blue Cross Blue Shield, The Health of America Report. Trends in Pregnancy and Childbirth Complications in the U.S. 2020. Accessed April 3, 2023. https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/HoA_Maternal_Health.pdf
- Ananth CV, Duzyj CM, Yadava S, Schwebel M, Tita ATN, Joseph KS. Changes in the Prevalence of Chronic Hypertension in Pregnancy, United States, 1970 to 2010. Hypertension. 2019;74(5): 1089-1095. doi:10.1161/HYPERTENSIONAHA. 119.12968
- Healthy People 2030. Reduce preterm births — MICH07. Office of Disease Prevention and Health Promotion, U.S. Dept. of Health and Human Services. Accessed April 3, 2023. https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/reduce-preterm-births-mich-07
- Brown HL, DeNicola N. Telehealth in Maternity Care. Obstet Gynecol Clin North Am. 2020;47 (3):497-502. doi:10.1016/j.ogc.2020.05.003
- Health Resources & Services Administration (HRSA). Telehealth and High Risk Pregnancy. Published April 12, 2022. Accessed April 26, 2023. https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-maternal-health-services/telehealth-and-high-risk-pregnancy
- Center for Connected Health Policy (CCHP). State Telehealth Laws and Reimbursement Policies- Fall 2020 Summary Chart of Key Telehealth Policy Areas. Published October 2022. Accessed April 26, 2023. https://www.cchpca.org/2022/10/Fall2022_SummaryChart1.pdf
- Justia Regulations. Advanced Telecommunications Services. Texas Administrative Code. January 23, 2023. Accessed May 10, 2023. https://regulations.justia.com/states/texas/title-1/part-15/chapter-354/subchapter-a/division-33/.
- Texas Department of State and Health Services (DSHS). Hear Her Texas. https://www.dshs.texas.gov/maternal-child-health/programs-activities-maternal-child-health/hear-her-texas
- Health Resources and Services Administration (HRSA). Texas Rural Maternity and Obstetrics Management Strategies (TX-RMOMS) Program. Published October 2021. Accessed May 10, 2023. https://www.hrsa.gov/sites/default/files/hrsa/rural-health/tx-rmoms-fact-sheet.pdf
- Texas Health & Human Services Commission. Welcome to Texas Presumptive Eligibility - Home Page. Accessed May 9, 2023. https://www.texaspresumptiveeligibility.com/UI/HomePage.aspx