New report finds alarming decline in US maternity care access

A new report by March of Dimes found that over 5.5 million women live in U.S. counties experiencing limited to no access to maternity care resources that include hospitals or birthing centers, obstetric care or obstetricians.

The report is the latest by the maternity care-centric nonprofit to highlight a worsening state of maternity care in the U.S., with a rise in closure of hospital obstetric units contributing to what the organization calls "a growing maternal and infant health crisis."

March of Dimes estimated that more than 2.3 million women of reproductive age live in counties deemed to be maternity care deserts, with approximately 150,000 births in these counties. More than 3 million additional women live in counties with limited maternity care access.

"We're going from bad to worse. We already have the worst maternal mortality rate of our industrial peer countries, and we know that access matters," Dr. Amanda Williams, March of Dimes' chief medical officer, told ABC News. "If we don't have access, then we don't even have a chance."

Maternity care deserts have a significant impact on health outcomes for expecting women. Data shows that women in maternity care deserts have a 13% chance of experiencing preterm birth, and receive inadequate prenatal care at higher rates, according to the report. Low-income and women of color are disproportionately affected.

People in maternity care deserts have to travel approximately 2.6 times further to receive care than those who live in counties where care exists, and early data has found that ob-gyns are leaving states with strictest abortion bans, Williams said.

"As the report suggests, the Dobbs decision -- the effects of which have yet to be fully realized -- is likely playing a major role in the already shrinking ob-gyn workforce in many rural areas of the country," Dr. Stella Dantas, president of the American College of Obstetricians and Gynecologists, said in a statement.

"As we continue to find ways to increase access, we must also vigorously combat legislative interference in the practice of medicine so that clinicians are free to practice without fear of criminalization and patients are able to get the care they need and deserve in the communities they live and raise their families in," the statement continued.

Approximately 35% of all US counties are now considered maternity care deserts, having no birthing facilities or obstetricians. North Dakota, South Dakota, Alaska, Oklahoma and Nebraska are the most impacted states, according to March of Dimes.

Since 2022, over 100 counties experienced a decline in maternity care access, totaling over 100 hospitals closing their obstetric units, resulting in delayed access to emergency care and forcing families to travel farther to receive critical care, according to the report.

Between 2015 and 2022, the prevalence of pre-pregnancy hypertension rose by over 80%, according to March of Dimes. Preeclampsia, a potentially fatal condition that causes a pregnant woman's blood pressure to rise, can lead to preterm birth, stroke, seizure, and other complications for expecting women.

In maternity care deserts, the rates of pre-pregnancy hypertension was 1.3 times higher than counties with full access to care, according to the report.

Leveraging telehealth services, improving reimbursement policies for obstetric services at hospitals, and improving access to midwifery services are some of the policy solutions to improve care, Williams noted.

"Not only are there people, a lot of people who live in these maternity care deserts, there are beautiful things, just as in the natural desert, you might find a gorgeous flower or cactus," Dr. Williams said. "There are churches, there are community centers, there are community based organizations. And so we need to figure out how in healthcare and in public health, we can partner with some of those organizations to be able to extend care to those who live in maternity care deserts."

ABC News' Sabina Ghebremedhin, Sony Salzman and Medical Unit resident Dr. Roshan Bransden contributed to this report.