Maternity care access in the U.S.
Key highlights
- 1 in 3 counties (34.6%) in the U.S. are maternity care deserts, with no obstetric clinicians or birthing facilities.
- 5.8 million women and 358,000 infants live in counties without full access to care.
- In some states, up to 1 in 5 women and infants live in maternity care deserts.
March of Dimes defines maternity care access at the county level using three factors: obstetric clinician availability, birthing facility availability, and insurance coverage among women of reproductive age. Counties are classified into 4 categories: full access, moderate access, low access, or maternity care desert.
Maternity care access designations
Indicator | Maternity care desert | Low access | Moderate access | Full access |
|---|---|---|---|---|
Hospitals and birth centers offering obstetric care | zero | <2 | <2 | ≥2 |
Obstetric clinicians per 10,000 births* | zero | <60 | <60 | ≥60 |
Proportion of women 19–54 without health insurance | any | ≥10% | <10% | any |
Note: Obstetric clinicians include obstetrician gynecologists (OB-GYNs), certified nurse midwives/certified midwives (CNMs/CMs), and family physicians who reported delivering babies. A county is full access if it meets 1 or more of the criteria.
1 in 3 U.S. counties (34.6%) is designated as a maternity care desert, defined as an area with no birthing facilities or obstetric clinicians. These counties are home to more than 2.4 million women of reproductive age, who gave birth to nearly 149,000 infants in 2024.
An additional 3.4 million women and 209,000 infants live in low- and moderate-access counties. In total, this means that nearly 1 in 12 women and 1 in 10 infants in the U.S. live in areas without full access to maternity care.
Geographic patterns vary across regions. The South and Midwest have the greatest proportion of counties designated as maternity care deserts (38.7%), though a smaller share (5-6%) of women and infants in these regions live in maternity care deserts overall. However, in some states, such as Mississippi, West Virginia, and North Dakota, as many as 1 in 5 women and infants live in maternity care deserts, increasing to 1 in 4 when including low- and moderate-access counties.
States with the largest numbers of women and infants impacted include North Carolina, Texas, and Tennessee, which together account for more than 1.2 million women and 82,000 infants living in areas with limited access to maternity care.
Maternity care deserts are not only defined by a lack of clinicians and facilities, but they also share demographic and economic characteristics that further limit access to care. These counties are more likely to be rural, have lower median household incomes, and have higher uninsured rates among women.
Maternity care deserts in the literature
Research consistently shows that living in a maternity care desert is associated with worse outcomes for moms and babies. Compared to individuals in full-access counties:
- Infants face a higher risk of mortality.2
- Women face a higher risk of pregnancy associated mortality.3,4
- Medicaid recipients are less likely to receive timely prenatal and postpartum care, and infants are less likely to be vaccinated.5
- Have fewer mental health clinicians and pediatricians.5