Maternity Care Desert: America's Silent Health Crisis
In a stark revelation, a new report from March of Dimes has shed light on a growing healthcare crisis in the United States. The nation is grappling with a severe shortage of maternity care providers, leaving vast swathes of the country without adequate obstetric care.
Key Findings
One-third of U.S. counties lack a single obstetric clinician
Projected shortage of 12,000 to 15,000 ob/gyns by 2050
Increasing trend of hospital obstetric unit closures
The report paints a grim picture of the state of maternal healthcare in America. Dr. Amanda Williams, interim chief medical officer for March of Dimes, points to a "significant uptick" in hospital obstetric unit closures over the past five years. This trend is driven by a perfect storm of challenges:
Staffing shortages
Poor reimbursement rates
Low birth volumes
These factors are forcing hospitals to make difficult decisions, often resulting in the closure of obstetric units. The consequence? Expectant mothers are left with increasingly limited options for delivery care.
A Multifaceted Problem
The crisis extends beyond just ob/gyns. The healthcare system is experiencing shortages across the board:
Nursing staff
Family practice doctors
Midwives
These shortages have been exacerbated by the COVID-19 pandemic, which has strained healthcare resources and personnel to their limits.
The Domino Effect
The implications of this crisis are far-reaching. As ob/gyns and family physicians who deliver babies leave the workforce, access to care worsens. This creates a vicious cycle, potentially leading to poorer maternal and infant health outcomes in affected areas.
Looking Ahead
As the United States faces this mounting challenge, urgent action is needed to address the root causes of the maternity care crisis. Solutions may involve:
Improving healthcare workforce retention
Enhancing reimbursement models for obstetric care
Developing innovative care delivery models to serve rural and underserved areas
Without swift and decisive action, the maternity care desert in America risks expanding, potentially jeopardizing the health and well-being of countless mothers and newborns across the nation.
The Rural-Urban Divide in Maternity Care: A Growing Concern
Family Physicians: Unsung Heroes of Rural Maternity Care
In the face of America's maternity care crisis, family physicians are emerging as crucial providers in underserved areas. A recent report highlights their significant role:
1 in 4 obstetric clinicians in rural counties are family physicians
In contrast, only 1 in 20 obstetric clinicians in urban counties are family physicians
Rural family physicians are more likely to report delivering babies compared to their urban counterparts
This disparity underscores the vital role family physicians play in bridging the maternity care gap in rural America.
The Ripple Effects of the Dobbs Decision
The 2022 Supreme Court decision overturning Roe v. Wade continues to reshape the landscape of obstetric care:
States with the most restrictive abortion laws face severe consequences for physicians
Potential risks include loss of medical licenses and imprisonment for providing medically necessary abortions
Data from 2021 revealed fewer ob/gyns per 10,000 births in states where abortion is now prohibited
Dr. Amanda Williams notes, "In states with the strictest abortion bans, an increasing number of providers report changes in their ability to care for patients.
The Stark Reality: Maternity Care Deserts
The March of Dimes report paints a concerning picture:
Over 35% of US counties are classified as "maternity care deserts"
1,104 counties have no birthing facilities or obstetric clinicians
These counties are home to more than 2.3 million women of reproductive age
This lack of access to maternity care facilities and professionals poses significant risks to maternal and infant health in large swaths of the country.
The Urban-Rural Divide
The disparity in maternity care access between urban and rural areas is striking:
Rural areas rely heavily on family physicians for obstetric care
Urban areas have a higher concentration of specialized ob/gyns
The Dobbs decision may exacerbate this divide, potentially driving more providers to states with less restrictive laws
Looking Ahead: Addressing the Crisis
As the US grapples with this complex issue, potential solutions may include:
Incentivizing family physicians to practice in rural areas
Expanding telemedicine services for prenatal and postpartum care
Developing policies to support and retain ob/gyns in underserved areas
Creating comprehensive strategies to address the broader healthcare workforce shortage
The path forward requires a multifaceted approach, recognizing the unique challenges faced by both rural and urban communities in ensuring access to quality maternity care for all.
The Silent Crisis: Maternity Care Deserts and Their Far-Reaching Impact
A Startling Reality
In 2022, over 150,000 babies were born to women living in maternity care deserts across the United States. These areas, characterized by limited or no access to maternity care services, are not just inconvenient—they're dangerous.
13% higher risk of preterm birth in maternity care deserts
6 out of 10 maternity care deserts are in rural areas
The Pandemic's Ripple Effect
The COVID-19 pandemic has exacerbated an already precarious situation:
Financial challenges forcing hospitals to cut obstetric services
Increasing number of maternity care deserts
A "steadily more dire situation," according to ACOG President Dr. Stella Dantas
A Call to Action: ACOG's Multi-Pronged Approach
The American College of Obstetricians and Gynecologists (ACOG) is spearheading efforts to combat this crisis:
Policy Advocacy
Improved reimbursement for obstetric services
Decreased administrative burdens on healthcare providers
Education and Training
Focus on nonobstetric healthcare professionals
Emergency medical services practitioners trained in stabilizing pregnant and postpartum patients
Collaboration with Federal Agencies
Partnering with CDC and Health Resources and Services Administration
Providing resources to rural medical facilities for managing pregnancy-related emergencies
The Dobbs Decision: A Complicating Factor
The 2022 Supreme Court decision overturning Roe v. Wade is "likely playing a major role" in the shrinking ob/gyn workforce in rural areas. Dr. Dantas emphasizes the need to:
Combat legislative interference in medical practice
Protect clinicians from criminalization
Ensure patients can access necessary care in their communities
Looking Ahead: A Holistic Approach
Addressing the maternity care desert crisis requires a multi-faceted strategy:
Policy changes to support rural healthcare
Enhanced training for a wider range of healthcare professionals
Telemedicine and mobile health solutions
Community-based support systems for pregnant women
Addressing the broader socioeconomic factors that contribute to healthcare disparities
As the situation evolves, it's clear that innovative solutions and concerted efforts from policymakers, healthcare providers, and communities are crucial to ensure safe and accessible maternity care for all women, regardless of their geographic location.
The Geography of Maternal Risk: Mapping America's Maternity Care Deserts
States in Crisis: Where Maternity Care is Hardest to Find
Recent data paints a stark picture of maternity care access across the United States. The following states have the highest percentage of counties classified as maternity care deserts:
North Dakota: 73.6%
South Dakota: 57.6%
Oklahoma: 51.9%
Missouri: 51.6%
Nebraska: 51.3%
Arkansas: 50.7%
These numbers reveal a troubling trend: in some states, over half of all counties lack adequate maternity care facilities.
The Journey to Care: Distance as a Barrier
Access to care isn't just about availability—it's also about proximity. The March of Dimes report highlights significant disparities in travel times to birthing hospitals:
National average: 16 minutes by car (without traffic)
Maternity care deserts: 38 minutes
Rural areas: 26 minutes
Residents in maternity care deserts face travel times 2.6 times longer than the national average, potentially risking their health and that of their unborn children.
The Ripple Effects of Limited Access
Dr. Amanda Williams, from March of Dimes, emphasizes the tangible impacts of living in a maternity care desert:
13% increased risk of preterm birth
Significantly lower likelihood of receiving adequate prenatal care
These statistics underscore the urgent need for targeted interventions in underserved areas.
A National Crisis by the Numbers
The scale of the maternity care crisis is alarming:
52% of US counties lack a hospital providing obstetric care
Between 2021 and 2022, 1 in 25 obstetric units closed nationwide
In 2022:
97.7% of US births occurred in hospitals
Yet, nearly 6 million women of reproductive age lived in counties without hospital obstetric services
1 in 10 babies were born in these underserved areas
The Path Forward
This data provides a crucial foundation for targeted interventions. As Dr. Williams notes, "We can be even more targeted in knowing that we can make a difference in these areas." Potential strategies may include:
Mobile health clinics to serve rural areas
Telemedicine initiatives for prenatal and postnatal care
Incentives for healthcare providers to work in underserved areas
Investment in rural hospitals and obstetric units
Policy changes to support maternal health in maternity care deserts
By understanding the geography of maternal risk, policymakers and healthcare providers can work towards ensuring that every expectant mother has access to the care she needs, regardless of where she lives.
Birth Centers: A Growing Alternative in America's Changing Maternity Care Landscape
The Decline of Hospital Childbirth Units
Over the past five years, a concerning trend has emerged in the United States:
1 in 10 counties have lost hospital childbirth units
This reduction exacerbates the already challenging access to maternity care in many areas
The Birth Center Revolution
Amidst this decline, a new trend is taking shape: the rise of birth centers.
What are Birth Centers?
Freestanding health care facilities specifically for childbirth
An alternative for mothers seeking options between hospital and home births
Often led by midwives
The Growing Popularity
From 2017 to 2022:
20% increase in births at birth centers
Rise from 19,878 to 23,945 births
The Current Landscape of Birth Centers
Despite their growing popularity, birth centers remain limited in number and distribution:
416 licensed birth centers nationwide
Spread across 270 counties
Less than 5% located in rural areas
Concentration in Key States
70% of all birth centers are found in just 10 states:
Arizona
California
Florida
Idaho
Oregon
Texas
Utah
Virginia
Washington
Wisconsin
The Potential of Birth Centers
Dr. Amanda Williams of March of Dimes highlights the strategic role birth centers could play:
Ideal for low-risk patients needing minimal intervention
Viable option in communities unable to support full hospital units
Can work in conjunction with nearby hospitals
Addressing the Maternity Care Crisis
March of Dimes proposes several strategies to improve access to maternity care:
Expand training opportunities for midwives
Invest in telehealth to reach more patients
Leverage birth centers as a cost-effective alternative to hospital units
Dr. Williams emphasizes: "We need to expand our ability to take care of patients, and low-risk patients really are best taken care of by the experts in physiologic birth, and that is midwifery care.
Looking Ahead
As the United States grapples with its maternity care crisis, birth centers emerge as a promising solution. Their growth could help address the gaps left by closing hospital units, especially in underserved areas. However, challenges remain:
Ensuring equitable distribution of birth centers, especially in rural areas
Integrating birth centers into the broader healthcare system
Addressing regulatory and funding challenges to support birth center expansion
By embracing innovative models like birth centers and strengthening midwifery care, the U.S. has an opportunity to reshape its maternity care landscape, potentially improving outcomes for mothers and babies across the nation.
The Midwifery Gap: How the US Lags Behind in Maternal Care
A Stark Contrast: US vs. Europe
The United States stands in sharp contrast to its European counterparts when it comes to midwifery care:
US: Only about 10% of births attended by midwives
Europe: Vast majority of births overseen by midwives
This disparity isn't just a matter of practice preference—it correlates with significant health outcomes.
The Midwifery Advantage
Research indicates that increased midwifery care in the US could lead to:
Decreased rates of C-sections
Lower incidence of preterm births
These benefits are particularly notable when patients are under the care of nurse midwives.
A Broader Issue: Public Health Infrastructure
Dr. Georges Benjamin, executive director of the American Public Health Association, describes the findings as "quite frightening." He points to a systemic issue:
Underfunding of public health infrastructure
Lack of comprehensive health system planning
The Geography of Healthcare Disparity
The maternity care crisis is not evenly distributed across the nation. Areas with inadequate maternity care often overlap with regions facing other healthcare challenges:
Primarily in the South and parts of the Midwest
Coincides with areas of:
Inadequate access to health insurance
Highest morbidity and mortality rates for chronic diseases
The Ripple Effect
The lack of maternity care access is symptomatic of broader healthcare system failures:
Insufficient policies ensuring universal care access
Absence of strategic health system planning
Looking Forward: Potential Solutions
To address these critical issues, several approaches could be considered:
Increased investment in midwifery education and training
Policy changes to integrate midwives more fully into the healthcare system
Targeted efforts to improve healthcare access in underserved regions
Comprehensive health system planning at state and federal levels
Public education on the benefits of midwifery care
A Call to Action
The stark contrast between the US and other developed nations in midwifery utilization and maternal health outcomes serves as a call to action. By learning from successful models abroad and addressing systemic healthcare disparities at home, the US has the opportunity to significantly improve its maternal care landscape.
As Dr. Benjamin emphasizes, what's needed is not just incremental change, but a fundamental rethinking of "health system planning and policies to ensure that people have access to care." Only through such comprehensive reform can the US hope to close the gap in maternal care and improve outcomes for mothers and babies across the nation.
The Midwifery Gap: How the US Lags Behind in Maternal Care
A Stark Contrast: US vs. Europe
The United States stands in sharp contrast to its European counterparts when it comes to midwifery care:
US: Only about 10% of births attended by midwives
Europe: Vast majority of births overseen by midwives
This disparity isn't just a matter of practice preference—it correlates with significant health outcomes.
The Midwifery Advantage
Research indicates that increased midwifery care in the US could lead to:
Decreased rates of C-sections
Lower incidence of preterm births
These benefits are particularly notable when patients are under the care of nurse midwives.
A Broader Issue: Public Health Infrastructure
Dr. Georges Benjamin, executive director of the American Public Health Association, describes the findings as "quite frightening." He points to a systemic issue:
Underfunding of public health infrastructure
Lack of comprehensive health system planning
The Geography of Healthcare Disparity
The maternity care crisis is not evenly distributed across the nation. Areas with inadequate maternity care often overlap with regions facing other healthcare challenges:
Primarily in the South and parts of the Midwest
Coincides with areas of:
Inadequate access to health insurance
Highest morbidity and mortality rates for chronic diseases
The Ripple Effect
The lack of maternity care access is symptomatic of broader healthcare system failures:
Insufficient policies ensuring universal care access
Absence of strategic health system planning
Looking Forward: Potential Solutions
To address these critical issues, several approaches could be considered:
Increased investment in midwifery education and training
Policy changes to integrate midwives more fully into the healthcare system
Targeted efforts to improve healthcare access in underserved regions
Comprehensive health system planning at state and federal levels
Public education on the benefits of midwifery care
A Call to Action
The stark contrast between the US and other developed nations in midwifery utilization and maternal health outcomes serves as a call to action. By learning from successful models abroad and addressing systemic healthcare disparities at home, the US has the opportunity to significantly improve its maternal care landscape.
As Dr. Benjamin emphasizes, what's needed is not just incremental change, but a fundamental rethinking of "health system planning and policies to ensure that people have access to care." Only through such comprehensive reform can the US hope to close the gap in maternal care and improve outcomes for mothers and babies across the nation.
