Millions of women in US have limited or no access to maternal care, new report finds

As the number of women who die due to childbirth complications continues to grow in the United States, so too does the number of women who live with little or no access to maternal care, according to a new report.

More than 5.6 million women in the U.S. live in counties with limited or no access to maternity care services, according to a report released Tuesday by the March of Dimes, a nonprofit organization focused on improving the health of pregnant people and babies.

In the past five years since March of Dimes started releasing its annual report on maternity care, hospitals in the U.S. lost over 300 birthing units. Hospitals in nearly one in 10 counties across the country have lost obstetric services, according to the 2023 report.

Since the first report in 2018, there has been a 4% increase in maternity care deserts, defined by March of Dimes as "any county in the United States without a hospital or birth center offering obstetric care and without any obstetric providers."

And since last year's report, 70 counties in the U.S. have had worse access to maternity care, according to March of Dimes.

“Think about that word access. That means that they don't come into the hospital. They can't drive just 30 minutes to come in for an emergency c-section or their hypertensive crisis. You’re talking about worst outcomes within delivery time," Dr. Elizabeth Cherot, CEO and president of March of Dimes, told ABC News' Janai Norman. "Now, think about access in the sense [of], 'I'm not going to drive 150 miles or fly to go have my prenatal visit, so I'm not going to go and get seen.'"

Cherot continued: "We know that women who don't have prenatal care are three to four times more likely to die compared to women who have prenatal care. That's the crisis."

The March of Dimes' report found that nearly every state has some areas of maternity care deserts, with the biggest prevalence in the Midwestern and Southern states.

In Alabama, nearly 90% of women living in rural areas of the state have no maternity care hospitals within 30 minutes of their home, according to the report.

New Mexico was found to have the highest rate of inadequate prenatal care, followed by Hawaii, Florida and Texas.

Texas, a state that is home to around 15 million women, according to census data, was found in the report to have the "highest reproductive health vulnerability of all U.S. states."

According to the report, over 46% of counties in Texas are defined as maternity care deserts and 20% of birthing people in the state received "no or inadequate prenatal care."

In the U.S., the national average of birthing people who receive no or inadequate prenatal care is nearly 15%.

Craig, Colorado, a city of nearly 9,000 people, had a full-time maternity unit in its local hospital until January 2020, when the unit closed.

Now, pregnant patients have to wait until their physician comes for a scheduled appointment or drive to Steamboat Springs, around 40 miles away.

"It's a lot to receive a phone call from a patient who lives hours from the hospital and try to navigate what to do in different situations," Dr. Elaine Stickrath, a Steamboat Springs-based OBGYN at UCHealth who travels to Craig each week to provide care, told Norman.

"Within 30 minutes would be a time where if somebody was having an obstetric emergency, the provider would be able to intervene and help, so if someone was having a major complication in pregnancy and was two hours from us, that's a long time in an emergency," Stickrath said. "It's no different than if someone was having a heart attack or some other medical emergency."

Jennifer Riley, CEO of Memorial Regional Health, the hospital in Craig, said the decision to close the hospital's maternity unit came at a time when the unit was delivering around 130 babies per year.

"We were really facing some very serious financial hardships, but the other piece was that we were starting to see a decreasing number of births in our community," Riley told ABC News. "When you're talking about something that is a service that needs to be available 24/7, you need to have staff that are available 24/7 and competent 24/7, so we made the really tough choice at that time to close that service."

Throughout Colorado, over 37% of counties have no birthing center, according to March of Dimes.

Over 32 million women 'vulnerable to poor health outcomes'

The new data on maternal care is the first to be released by March of Dimes since last year's Supreme Court decision that overturned Roe v. Wade and the constitutional right to abortion in the U.S.

Since that decision, 15 states have ceased nearly all abortion services, and many others have enacted restrictions.

Across the country, March of Dimes found in its report that more than 32 million women of reproductive age are "vulnerable to poor health outcomes" because they lack access to reproductive health care services.

The growing lack of reproductive health care for women comes as the maternal health crisis also continues to grow in the U.S., particularly for Black women and Native American women.

Across all races, the U.S. has one of the highest maternal mortality rates in the world, with around 700 women dying each year as a result of complications due to pregnancy, according to the U.S. Centers for Disease Control and Prevention.

Black women and Native American women who give birth in the U.S. are two to three times as likely to die from a pregnancy-related cause than white women, according to the CDC.

People of color often face discrimination or other gaps in care when receiving health care, and that is linked to poorer treatment, according to a study published in the American Journal of Public Health.

According to March of Dimes’ report, American Indian and Alaska Native women received the highest rate of inadequate prenatal care, followed closely by Black women.

The report also found that Black and American Indian and Alaska Native women are more likely to have chronic health conditions that can lead to poor outcomes in pregnancy, an issue that is magnified in areas of maternity care deserts.

To try to help reach pregnant women in underserved areas, March of Dimes has operated mobile health units in different states for the past several years.

The organization also focuses on policy changes through its so-called Mamagenda which calls on lawmakers to pass legislation to improve maternal care.

“We've been sounding the alarm for some time," Cherot said. "I feel like it's not being heard."

She continued, "The data is out there. We know it. We just need help."