Maternity Care Deserts

Written by: Jess Kimball

A maternity care desert is a county in the United States that does not have access to a hospital or other resource offering obstetric care. Around 36% of the counties in the United States are considered maternity care deserts. The number of counties increased by 2% from 2020 to 2022 and the outcomes in many of those counties have during those years. The COVID-19 pandemic exacerbated the problem, with a loss of obstetric providers and adequate funding. 

Two-thirds of maternity care deserts are in rural areas where access to transportation for travel to other counties is limited. These areas may also have limited access to broadband internet, making telehealth impossible for many individuals. In 2022, only 7% of practicing midwives and obstetricians resided in rural areas. Access to care disproportionately impacts low-income families, who are more likely to reside in rural areas. 

This creates yet another disparity in birth and postpartum outcomes in America. The United States has the highest maternal mortality rate of any industrialized country; that rate is nearly four times higher for people of color. 

Individuals who live in maternity care deserts can benefit from the midwifery model of care, which oftentimes includes care brought right to the birthing person’s home. If a birthing person is delivering with a midwife at a birth center, the option for appointments at home can lower the necessary travel required from the patient to only the birth itself, making access to care much easier. Individuals can also seek out family medicine practices for basic reproductive care and pediatrics for their infants. While this does not close the gap in care completely, these are options to be aware of. 

Stakeholders can look into offering mobile services, community models of care, and policy changes. Mobile reproductive health units can bring basic reproductive care to rural areas where access to services like Planned Parenthood is not available. The community model of care has been proven to lead to desirable outcomes for the birthing population. 

Community-based midwifery care has demonstrated reductions in preterm birth, low birth weight, and cesarean section. Community-based doulas can also help to increase the likelihood of a positive birth and postpartum outcome. Care from a doula increases the likelihood of breastfeeding in the postpartum diad, reducing the need to make frequent trips to a store for formula and improving health outcomes for parent and baby. This is especially important at a time when formula shortages are becoming more common and are impacting rural communities, which tend to be food deserts, more than other areas. 

Organizations such as Bluecross Blueshield of North Carolina are working to increase insurance reimbursement for doulas and lactation providers in order to meet the needs of their covered communities. Employee benefits of doula care and increased insurance reimbursement for doulas are two ways to increase access to care for rural families. 

To make options more accessible in rural areas, policy changes need to occur. 

Necessary policy changes include, but are not limited to; increasing Medicaid eligibility to include all midwives in all settings; adequate coverage of home and birth center births; investments in doula care and other community-based perinatal providers; and investment in rural maternity centers. 

At Global Foundation for Girls (GFG), we are active thought partners, serving global communities of birthing persons in order to advance and support the advocacy movement. We lead webinars and trainings for providers including doulas, social workers, childbirth educators, and more! To learn more about our upcoming trainings click here!

Jess Kimball, AS, CLC, CD, PCD, PMH-C