Consistent, high-quality maternity care is essential to protect the health of all moms and babies. Maternity care encompasses health care services for women during pregnancy, delivery and postpartum.1 With over 3.5 million births in the U.S. annually,2 and rising rates of maternal mortality and morbidity, there is ample opportunity to improve maternal and birth outcomes in our country. The 2022 Nowhere to Go: Maternity Care Deserts Across the U.S. report is an update of the 2020 report and aims to increase education and raise awareness about maternity care deserts. Along with data and maternity care deserts classification updates, new topics touching on the postpartum period, the importance of telehealth and the intersection of chronic disease and pregnancy are included.
Policy Solutions And Actions
Improve access to quality and affordable preconception, prenatal and postpartum care
- Expand Medicaid for individuals who fall at or below 138 percent of the Federal Poverty Level (FPL).
- Raise parental income eligibility levels under Medicaid.
- Extend the Medicaid postpartum coverage period to 12 months.
- Expand access to midwifery care and integrate midwives and their model of care in all states.
- Reimbursement for doula care.
- Provide coverage for evidence-based telehealth services for pregnant and postpartum women and support alignment of telehealth reimbursement approaches across payers.
- Enhance perinatal regionalization as a strategy to improve both maternal and neonatal outcomes. Strengthening network requirements for the Affordable Care Act (ACA) market plans.
Prevention and treatment
- Address social determinants of health to reduce disparities to improve opportunities for health equity.
Research and surveillance
- Improve maternal mortality and morbidity data collection and surveillance and prioritize policy recommendations from Maternal Mortality Review Committees (MMRC).
- Perinatal Quality Collaboratives (PQC) provide infrastructure that supports all U.S. states and territories having a PQC.
- Maternity Care Deserts
- Between the 2020 and 2022 reports, three percent of counties across the U.S. shifted maternity care classification due to increased access to care and five percent of counties shifted in classification due to decreased access to care.
- Obstetric providers were the primary driver of designation change for increases or decreases in access, as 56 counties shifted to a lower level of access due to loss of obstetric providers, while 55 increased in access due to an increase of obstetric providers.
- Hospitals limiting obstetric services decreased access to care in 37 counties, while the expansion of hospital obstetric services increased access to care in eight counties.
- Over 2.8 million women of childbearing age and nearly 160,000 babies were impacted by reduced access to maternity care.
Source: U.S. Health Resources and Services Administration (HRSA), Area Health Resources Files, 2021.
Definitions of maternity care deserts and access to maternity care
Definitions(Click to sort ascending)Maternity care deserts(Click to sort ascending)Low access to maternity care(Click to sort ascending)Moderate access to maternity care(Click to sort ascending)Full access to maternity care(Click to sort ascending)Hospitals and birth centers offering obstetric carezero<2<2>2Obstetric Providers (obstetrician, CNM/CM) per 10,000 Birthszero<60<60≥60Proportion of women 18-64 without health insurance*any≥10%<10%any
- Notes: CNM/CM = certified nurse midwives/certified midwives.
- *U.S. average is approximately 11%.
- Source: Kaiser Family Foundation. https://www.kff.org/womens-health-policy/fact-sheet/womens-health-insurance-coverage-fact-sheet/
Distribution of counties, women (15-44 yrs.) and births by access to maternity care
- Source: U.S. Health Resources and Services Administration (HRSA), Area Health Resources Files, 2021; National Center for Health Statistics. Final natality data, 2020; U.S. Census Bureau, County Population by Characteristics, 2020.
Maternity care deserts Low access to maternity care Moderate access to maternity care Full access to maternity care TotalCharacteristic(Click to sort ascending)Count(Click to sort ascending)Percent(Click to sort ascending)Count(Click to sort ascending)Percent(Click to sort ascending)Count(Click to sort ascending)Percent(Click to sort ascending)Count(Click to sort ascending)Percent(Click to sort ascending)Count(Click to sort ascending)Counties1,11935.637311.92237.11,42745.43,142Women 15–44 yrs2,247,9633.53,030,5284.71,670,5492.657,593,11989.264,542,159Births146,5973.9197,6285.3103,9322.83,299,84388.03,748,000
Access to maternity care and economic characteristics
Characteristic(Click to sort ascending)Maternity care deserts (n=1119 counties) Mean(Click to sort ascending)Low access to maternity Care (n=373 counties) Mean(Click to sort ascending)Moderate access to maternity care (n=223 counties) Mean(Click to sort ascending)Full access to maternity care (n=1427 counties) Mean(Click to sort ascending)Median household income$50,206$51,687$58,596$60,604Women without health insurance (18-64 yrs.)*13.7%16.5%7.5%11.1%Population in poverty**16.0%17.0%13.1%14.2%Urban Counties18.6%30.6%37.7%53.2%
- *Source: U.S. HRSA, Area Health Resource File, 2021, data from 2019.
- **Source U.S. HRSA, Area Health Resource File, 2021, data from 2015-2019.
Urban and rural county maternity care deserts characteristics
Characteristic(Click to sort ascending)Urban Counties (n=208 counties) Mean(Click to sort ascending)Rural Counties (n=911 counties) Mean(Click to sort ascending)Median household income$54,715$49,174Women without health insurance (18-64 yrs.)*13.0%13.9%Population in poverty**15.0%16.3%
- *Source: U.S. HRSA, Area Health Resource File, 2021, data from 2019.
- **Source U.S. HRSA, Area Health Resource File, 2021, data from 2015-2019.
- Federally Qualified Health Centers
- Health Insurance Before, During and After Pregnancy Among Women
- Perinatal Regionalization and Risk-Appropriate Levels of Care
- Access to Telehealth During Pregnancy
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