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Nowhere to go: Maternity Care Deserts across the U.S. 2022 Report

The cover of the Maternity Care Deserts report.

Download the full report as a PDF in English or in Spanish.

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.

Key Findings

Key Finding 1
Key Finding 2
Key Finding 3
Key Finding 4
Key Finding 5
Interactive maps can be found in the sections below. Click any title in each map's legend to turn on and off that section on the map. Hover (on desktop) or tap (on mobile) on each county on the map for more specific information.
  1. 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 care
    zero
    <2
    <2
    >2
    Obstetric Providers (obstetrician, CNM/CM) per 10,000 Births
    zero
    <60
    <60
    ≥60
    Proportion of women 18-64 without health insurance*
    any
    ≥10%
    <10%
    any

    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 Total
    Characteristic
    (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)
    Counties
    1,119
    35.6
    373
    11.9
    223
    7.1
    1,427
    45.4
    3,142
    Women 15–44 yrs
    2,247,963
    3.5
    3,030,528
    4.7
    1,670,549
    2.6
    57,593,119
    89.2
    64,542,159
    Births
    146,597
    3.9
    197,628
    5.3
    103,932
    2.8
    3,299,843
    88.0
    3,748,000

    Access to maternity care and economic characteristics

    • *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.
    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
    $60,604
    Women 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 Counties
    18.6%
    30.6%
    37.7%
    53.2%

    Urban and rural county maternity care deserts characteristics

    • *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.
    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
    $49,174
    Women without health insurance (18-64 yrs.)*
    13.0%
    13.9%
    Population in poverty**
    15.0%
    16.3%
  2. Hospitals
  3. Federally Qualified Health Centers
  4. Providers
  5. Health Insurance Before, During and After Pregnancy Among Women
  6. Perinatal Regionalization and Risk-Appropriate Levels of Care
  7. Access to Telehealth During Pregnancy

References

  1. World Health Organization. Maternal Health. Available at: https://www.who.int/health-topics/maternal-health#tab=tab_1. Accessed May 17, 2022.
  2. Osterman M, Hamilton B, Martin JA, Driscoll AK, Valenzuela CP. Births: Final Data for 2020. Natl Vital Stat Rep. 2021;70(17):1-50.
  3. Hoyert DL. Maternal mortality rates in the United States, 2020. NCHS Health E-Stats. 2022. Available at: https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2020/maternal-mortality-rates-2020.htm. Accessed May 17, 2022.
  4. Hoyert DL. Maternal mortality rates in the United States, 2019. NCHS Health E-Stats. 2021. Available at: https://www.cdc.gov/nchs/data/hestat/maternal-mortality-2021/maternal-mortality-2021.htm. Accessed May 17, 2022.
  5. Centers for Disease Control and Prevention. Severe Maternal Morbidity in the United States. Available at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html#anchor_trends. Accessed May 13, 2022.
  6. Building U.S. Capacity to Review and Prevent Maternal Deaths. 2018. Report from nine maternal mortality review committees. Available at: https://reviewtoaction.org/node/122. Accessed May 17, 2022.
  7. World Health Organization. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization. 2019. Available at: https://apps.who.int/iris/handle/10665/327595. Accessed May 17, 2022.
  8. Barrera CM, Kramer MR, Merkt PT, et al. County-Level Associations Between Pregnancy-Related Mortality Ratios and Contextual Sociospatial Indicators. Obstet Gynecol. 2022;139(5):855-865.
  9. Dagher RK, Linares DE. A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality. Children (Basel). 2022;9(3):394.
  10. National Center for Health Statistics, 2020 final natality data.
  11. Howell EA. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clin Obstet Gynecol. 2018;61(2):387-399.
  12. Howell EA, Zeitlin J. Improving hospital quality to reduce disparities in severe maternal morbidity and mortality. Semin Perinatol. 2017;41(5):266-272.
  13. Howell EA, Egorova N, Balbierz A, Zeitlin J, Hebert PL. Blackwhite differences in severe maternal morbidity and site of care. Am J Obstet Gynecol. 2016;214(1):122.e1-122.e1227.
  14. Main EK, Chang SC, Dhurjati R, Cape V, Profit J, Gould JB. Reduction in racial disparities in severe maternal morbidity from hemorrhage in a large-scale quality improvement collaborative. Am J Obstet Gynecol. 2020;223(1):123.e1-123.e14.
  15. Schmitt N, Mattern E, Cignacco E, et al. Effects of the Covid-19 pandemic on maternity staff in 2020—a scoping review. BMC Health Serv Res. 2021;21(1):1364.
  16. Electronic Code of Federal Regulations (eCFR). Title 45, Subtitle A, Subchapter B, Part 156, Subpart C, § 156.230 Network adequacy standards. Available at: https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-156/subpart-C/ section-156.230. Accessed May 11, 2022.
  17. Centers for Medicare & Medicaid Services. HHS Notice of Benefit and Payment Parameters for 2023 Proposed Rule Fact Sheet. Available at: https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-and-payment-parameters-2023-proposed-rule-fact-sheet. Accessed May 11, 2022.
  18. The Center for American Progress. Strengthening Federal Network Adequacy Requirements for ACA Marketplace Plans. Available at: https://www.americanprogress.org/article/strengthening-federal-network-adequacy-requirements-for-aca-marketplace-plans/. Accessed May 11, 2022.
  19. U.S. Health Resources and Services Administration (HRSA), Area Health Resources Files, 2021.
  20. Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill. Rural Hospital Closures. Available at: https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures. Accessed May 17, 2022.
  21. Kozhimannil KB, Interrante JD, Tuttle MKS, Henning-Smith C. Changes in Hospital-Based Obstetric Services in Rural US Counties, 2014-2018. JAMA. 2020;324(2):197-199.
  22. American Hospital Association, 2019-2020.
  23. Hung P, Kozhimannil KB, Casey MM, Moscovice IS. Why Are Obstetric Units in Rural Hospitals Closing Their Doors? Health Serv Res. 2016;51(4):1546-1560.
  24. Hung P, Henning-Smith CE, Casey MM, Kozhimannil KB. Access To Obstetric Services In Rural Counties Still Declining, With 9 Percent Losing Services, 2004-14. Health Aff (Millwood). 2017;36(9):1663-1671.
  25. Hostetter M, Klein S. Restoring Access to Maternity Care in Rural America. The Commonwealth Fund. September 20, 2021. Available at: https://www.commonwealthfund.org/publications/2021/sep/restoring-access-maternity-care-rural-america. Accessed May 17, 2022.
  26. Alliman J, Phillippi JC. Maternal Outcomes in Birth Centers: An Integrative Review of the Literature. J Midwifery Womens Health. 2016;61(1):21-51.
  27. American Association of Birth Centers. Frequently Asked Questions about Birth Centers. Available at: https://www.birthcenters.org/page/BirthCenterFAQs. Accessed April 19, 2022.
  28. Caughey AB, Cheyney M. Home and Birth Center Birth in the United States: Time for Greater Collaboration Across Models of Care. Obstet Gynecol. 2019;133(5):1033-1050.
  29. American Association of Birth Centers, 2021.
  30. March of Dimes. Nowhere to Go: Maternity Care Deserts Across the U.S. 2020 Report. Available at: https://www.marchofdimes.org/peristats/assets/s3/reports/2020-Maternity-Care-Report.pdf. Accessed May 17, 2022.
  31. MacDorman MF, Barnard-Mayers R, Declercq E. United States community births increased by 20% from 2019 to 2020 [published online ahead of print, 2022 Feb 25]. Birth. 2022;10.1111/birt.12627.
  32. Health Resources & Services Administration (HRSA). Federally Qualified Health Centers. Available at: https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc/index.html. Accessed May 9, 2022.
  33. HRSA Bureau of Health Workforce. What is Shortage Designation? Available at: https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation. Accessed May 9, 2022.
  34. FQHC Associates. What is an FQHC? Available at: https://www.fqhc.org/what-is-an-fqhc. Accessed May 9, 2022.
  35. Shah JS, Revere FL, Toy EC. Improving Rates of Early Entry Prenatal Care in an Underserved Population. Matern Child Health J. 2018;22(12):1738-1742.
  36. Patterson DG, Andrilla CHA, Garberson LA. The Supply and Rural-Urban Distribution of the Obstetrical Care Workforce in the U.S. Policy Brief #168. WWAMI Rural Health Research Center, University of Washington; June 2020. Available at: https://familymedicine.uw.edu/rhrc/studies/the-supply-and-rural-urban-distribution-of-the-obstetrical-care-workforce-in-the-u-s. Accessed May 19, 2022.
  37. 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):1239-1247.
  38. The National Partnership for Women & Families. Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing. June 2018. Available at: https://www.nationalpartnership.org/our-work/health/reports/maternity-blueprint.html. Accessed May 19, 2022.
  39. Kozhimannil KB, Interrante JD, Henning-Smith C, Admon LK. Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007-15. Health Aff (Millwood). 2019;38(12):2077-2085.
  40. U.S. Health Resources and Services Administration (HRSA). Rural Maternity and Obstetrics Management Strategies (RMOMS) Program. Available at: https://www.hrsa.gov/rural-health/grants/rural-community/rmoms. Accessed May 19, 2022.
  41. Klibanoff E. Texas’ “maternity deserts” grow as staff shortages close rural labor and delivery units. The Texas Tribune. January 20, 2022. Available at: https://www.texastribune.org/2022/01/20/rural-hospital-texas-maternity-care-obstetrics. Accessed May 19, 2022.
  42. Sells CE, Maes AM, Fleddermann RA, Otero-Bell EL, Hartley RS. Impact of the COVID-19 pandemic on rural obstetrics practices in New Mexico. J Family Med Prim Care. 2021;10(3):1336-1340.
  43. Barreto T, Peterson LE, Petterson S, Bazemore AW. Family Physicians Practicing High-Volume Obstetric Care Have Recently Dropped by One-Half. Am Fam Physician. 2017;95(12):762.
  44. Taporco JS, Wolfe E, Chavez G, et al. Kansas maternity deserts: a cross-sectional study of rural obstetric providers. Rural Remote Health. 2021;21(1):6137.
  45. Barreto TW, Eden A, Hansen ER, Peterson LE. Opportunities and Barriers for Family Physician Contribution to the Maternity Care Workforce. Fam Med. 2019;51(5):383-388.
  46. Barreto TW, Eden AR, Petterson S, Bazemore AW, Peterson LE. Intention Versus Reality: Family Medicine Residency Graduates’ Intention to Practice Obstetrics. J Am Board Fam Med. 2017;30(4):405-406.
  47. American Academy of Family Physicians, 2021.
  48. American College of Nurse-Midwives. Definition of Midwifery and Scope of Practice of Certified Nurse-Midwives and Certified Midwives, 2021. Available at: https://www.midwife.org/About-the-Midwifery-Profession. Accessed March 30, 2022.
  49. The American Midwifery Certification Board. Certified NurseMidwives/Certified Midwives by State (as of February 2022). Available at: https://www.amcbmidwife.org/docs/default-source/reports/number-of-cnm-cm-by-state---may-2021.pdf. Accessed March 30, 2022.
  50. The Midwives Alliance of North America (MANA). Legal Status of U.S. Midwives. Available at: https://mana.org/about-midwives/legal-status-of-us-midwives. Accessed March 30, 2022.
  51. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2016;4(4):CD004667.
  52. Hamlin L, Grunwald L, Sturdivant RX, Koehlmoos TP. Comparison of nurse-midwife and physician birth outcomes in the military health system. Policy Polit Nurs Pract. 2021;22(2):105-113.
  53. Hunter B, Warren L. Midwives’ experiences of workplace resilience. Midwifery. 2014;30(8):926-934.
  54. Vanderlaan J, Woeber K. Early Perinatal Workforce Adaptations to the COVID-19 Pandemic. J Perinat Neonatal Nurs. 2022;36(1):37-45.
  55. ACNM Workforce Committee Pandemic Research Subcommittee. Midwifery Workforce Changes and Practice Effects of State Licensure and Regulation During the COVID-19 Pandemic. Oral presentation at: ACNM 66th Annual Meeting & Exhibition [Virtual]; May 23-25, 2021.
  56. American College of Nurse-Midwives, Accreditation Commission for Midwifery Education. Midwifery Education Trends Report 2019. Available at: https://www.midwife.org/default.aspx?bid=59&cat=12&button=Search.
  57. DONA International. What is a doula? Available at: https://www.dona.org/what-is-a-doula. Accessed March 31, 2022.
  58. ACOG Committee Opinion No. 766. Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol. 2019;133(2):e164-e173.
  59. DONA International. Position Paper: The Birth Doula’s Role in Maternity Care. Available at: https://www.dona.org/what-is-adoula/benefits-of-a-doula. Accessed March 31, 2022.
  60. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;7(7):CD003766.
  61. Searcy JJ, Castañeda AN. On the Outside Looking In: A Global Doula Response to COVID-19. Front Sociol. 2021;6:613978.
  62. March of Dimes. Policies & Positions. Doulas and Birth Outcomes (2019). Available at: https://www.marchofdimes.org/advocacy/policies-and-positions.aspx. Accessed March 31, 2022.
  63. The National Health Law Program. Doula Medicaid Project, Current State Doula Medicaid Efforts. Available at: https://healthlaw.org/doulamedicaidproject. Accessed March 31, 2022.
  64. ACOG Committee Opinion No. 736. Optimizing Postpartum Care. Reaffirmed 2021. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care. Accessed May 17, 2022.
  65. Daw JR, Kozhimannil KB, Admon LK. High Rates Of Perinatal Insurance Churn Persist After The ACA. Health Affairs Forefront. September 16, 2019. Available at: https://www.healthaffairs.org/do/10.1377/forefront.20190913.387157. Accessed May 17, 2022.
  66. Kaiser Family Foundation. Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2019: Findings from a 50-State Survey. March 2019. Available at: https://www.kff.org/medicaid/report/medicaid-and-chip-eligibility-enrollment-and-cost-sharing-policies-as-of-january-2019-findings-from-a-50-state-survey. Accessed May 17, 2022.
  67. Eliason EL, Daw JR, Steenland MW. Changes in Postpartum Insurance Coverage in the US During the COVID-19 Pandemic. JAMA Health Forum. 2022;3(4):e220688. Published online April 22, 2022.
  68. Centers for Disease Control. PRAMS (Pregnancy Risk Assessment Monitoring System) Data, 2019. Selected 2016 through 2019 Maternal and Child Health (MCH) Indicators. Available at: https://www.cdc.gov/prams/prams-data/mch-indicators.html. Accessed May 17, 2022.
  69. Ukah UV, Dayan N, Potter BJ, Ayoub A, Auger N. Severe Maternal Morbidity and Risk of Mortality Beyond the Postpartum Period. Obstet Gynecol. 2021;137(2):277-284.
  70. Lewkowitz AK, Rosenbloom JI, Keller M, et al. Association Between Severe Maternal Morbidity and Psychiatric Illness Within 1 Year of Hospital Discharge After Delivery. Obstet Gynecol. 2019;134(4):695-707.
  71. Petersen EE, Davis NL, Goodman D, et al. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. MMWR Morb Mortal Wkly Rep 2019;68:423-429.
  72. ACOG. Policy Priorities. Eliminating Preventable Maternal Mortality and Morbidity. Available at: https://www.acog.org/advocacy/policy-priorities/maternal-mortality-prevention. Accessed May 17, 2022.
  73. Bauman BL, Ko JY, Cox S, et al. Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression - United States, 2018. MMWR Morb Mortal Wkly Rep. 2020;69(19):575-581.
  74. Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017;210(5):315-323.
  75. Farr SL, Dietz PM, O’Hara MW, Burley K, Ko JY. Postpartum anxiety and comorbid depression in a population-based sample of women. J Womens Health (Larchmt). 2014;23(2):120-128.
  76. March of Dimes Position Statement. Improving Maternal Mental Health. Available at: https://www.marchofdimes.org/mental-health.aspx. Accessed May 17, 2022.
  77. ACOG Committee Opinion No. 762. Prepregnancy Counseling. January 2019. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/01/prepregnancy-counseling. Accessed May 16, 2022.
  78. Johnson K, Posner SF, Biermann J, et al. Recommendations to improve preconception health and health care—United States. A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel on Preconception Care. MMWR Recomm Rep. 2006;55(RR-6):1-23.
  79. Kaiser Family Foundation (KFF). Women’s Health Insurance Coverage. November 8, 2021. Available at: https://www.kff.org/other/fact-sheet/womens-health-insurance-coverage. Accessed May 16, 2022.
  80. National Center for Health Statistics, final natality data, 2016-2020.
  81. Truven Health Analytics. The cost of having a baby in the United States. Ann Arbor (MI): Truven Health Analytics. January 2013. Available at: https://www.catalyze.org/product/2013-cost-baby-united-states. Accessed May 16, 2022.
  82. Status of State Medicaid Expansion Decisions: Interactive Map. April 26, 2022. Available at: https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/. Accessed May 16, 2022.
  83. Holahan J, Buettgens M, Banthin JS, Simpson M. Issue Brief: Filling the Gap in States That Have Not Expanded Medicaid Eligibility. The Commonwealth Fund. June 30, 2021. Available at: https://www.commonwealthfund.org/publications/issue-briefs/2021/jun/filling-gap-states-not-expanded-medicaid. Accessed May 16, 2022.
  84. Kaiser Family Foundation (KFF). Medicaid Postpartum Coverage Extension Tracker. Available at: https://www.kff.org/medicaid/issue-brief/medicaid-postpartum-coverage-extension-tracker. Accessed June 16, 2022.
  85. U.S. Department of Health & Human Services. New Medicaid and CHIP Enrollment Snapshot Shows Almost 10 million Americans Enrolled in Coverage During the COVID-19 Public Health Emergency. June 21, 2021. Available at: https://www.hhs.gov/about/news/2021/06/21/new-medicaid-and-chip-enrollment-snapshot-shows-almost-10-million-americans-enrolled.html. Accessed May 16, 2022.
  86. Centers for Disease Control and Prevention. Pregnancy Mortality Surveillance System. Available at: https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm. Accessed May 13, 2022.
  87. Admon LK, Winkelman TNA, Moniz MH, Davis MM, Heisler M, Dalton VK. Disparities in Chronic Conditions Among Women Hospitalized for Delivery in the United States, 2005-2014. Obstet Gynecol. 2017;130(6):1319-1326.
  88. Admon LK, Winkelman TNA, Heisler M, Dalton VK. Obstetric Outcomes and Delivery-Related Health Care Utilization and Costs Among Pregnant Women With Multiple Chronic Conditions. Prev Chronic Dis. 2018;15:E21.
  89. Collier AY, Molina RL. Maternal Mortality in the United States: Updates on Trends, Causes, and Solutions. Neoreviews. 2019;20(10):e561-e574.
  90. Fingar KF, Hambrick MM, Heslin KC, Moore JE. Trends and Disparities in Delivery Hospitalizations Involving Severe Maternal Morbidity, 2006-2015. HCUP Statistical Brief #243. September 2018. Agency for Healthcare Research and Quality, Rockville, MD. Available at: www.hcup-us.ahrq.gov/reports/statbriefs/sb243-Severe-Maternal-Morbidity-Delivery-Trends-Disparities.pdf. Accessed May 13, 2022.
  91. Deloitte Consulting/Deloitte Health Equity Institute, HealthPrismTM. March of Dimes Maternity Care Deserts Final Report. March 2022.
  92. Ford ND, Cox S, Ko JY, et al. Hypertensive Disorders in Pregnancy and Mortality at Delivery Hospitalization— United States, 2017-2019. MMWR Morb Mortal Wkly Rep. 2022;71(17):585-591.
  93. ACOG Obstetric Care Consensus No. 9. Levels of Maternal Care. August 2019. Available at: https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2019/08/levels-of-maternal-care. Accessed May 18, 2022.
  94. American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 8th ed. Elk Grove Village, IL: AAP; Washington, DC:ACOG, 2017.
  95. American College of Obstetricians and Gynecologists and Society for Maternal–Fetal Medicine, Menard MK, Kilpatrick S, et al. Levels of maternal care. Am J Obstet Gynecol. 2015;212(3):259-271.
  96. Clapp MA, James KE, Kaimal AJ. The effect of hospital acuity on severe maternal morbidity in high-risk patients. Am J Obstet Gynecol. 2018;219(1):111.e1-111.e7.
  97. Handley SC, Lorch SA. Regionalization of neonatal care: benefits, barriers, and beyond [published online ahead of print, 2022 Apr 23]. J Perinatol. 2022;10.1038/s41372-022-01404-7.
  98. Okoroh EM, Kroelinger CD, Lasswell SM, Goodman DA, Williams AM, Barfield WD. United States and territory policies supporting maternal and neonatal transfer: review of transport and reimbursement. J Perinatol. 2016;36(1):30-34.
  99. Kroelinger CD, Okoroh EM, Goodman DA, Lasswell SM, Barfield WD. Designation of neonatal levels of care: a review of state regulatory and monitoring policies. J Perinatol. 2020;40(3):369-376.
  100. American Hospital Association, 2020.
  101. DeNicola N, Grossman D, Marko K, et al. Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes: A Systematic Review. Obstet Gynecol. 2020;135(2):371-382.
  102. Morgan A, Goodman D, Vinagolu-Baur J, Cass I. Prenatal telemedicine during COVID-19: patterns of use and barriers to access. JAMIA Open. 2022;5(1):ooab116.
  103. Vogels EA. Pew Research Center. Digital divide persists even as Americans with lower incomes make gains in tech adoption. July 22, 2021. Available at: https://www.pewresearch.org/fact-tank/2021/06/22/digital-divide-persists-even-as-americans-with-lower-incomes-make-gains-in-tech-adoption. Accessed May 13, 2022.
  104. Federal Communications Commission, Fixed Broadband Deployment Data. December 2020, 2021.
  105. Federal Communications Commission. 2016 Broadband Progress Report. January 29, 2016. Available at: https://www.fcc.gov/reports-research/reports/broadband-progress-reports/2016-broadband-progress-report. Accessed May 13, 2022.
  106. Fryer K, Delgado A, Foti T, Reid CN, Marshall J. Implementation of Obstetric Telehealth During COVID-19 and Beyond. Matern Child Health J. 2020;24(9):1104-1110.
  107. Marshall J, Kihlström L, Buro A, et al. Statewide Implementation of Virtual Perinatal Home Visiting During COVID-19. Matern Child Health J. 2020;24(10):1224-1230.
  108. Dills AK. Mercatus Center at George Mason University. Policy Brief. Telehealth Payment Parity Laws at the State Level. November 2021. Available at: https://www.mercatus.org/publications/healthcare/telehealth-payment-parity-laws-state-level. Accessed May 13, 2022.
  109. March of Dimes Policy Statement. Telehealth in Maternal and Child Health Care. April 2020. Available at: https://www.marchofdimes.org/advocacy/policies-and-positions.aspx. Accessed May 13, 2022.
  110. Ingram DD, Franco SJ. 2013 NCHS urban–rural classification scheme for counties. National Center for Health Statistics. Vital Health Stat 2(166). 2014.
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