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Pregnant women living in areas with limited access to maternity care face significant challenges that can affect the safety and health of both the mother and baby. This issue is becoming increasingly common, with many counties in the United States, especially in rural areas, being classified as maternity care deserts—places where there is no hospital or birth center and no obstetric providers. According to a 2024 March of Dimes report, over one-third of U.S. counties lack access to such care, leaving over 2.3 million women without vital maternity services.
Factors such as financial strain, reduced insurance reimbursements, provider shortages, and restrictive laws are exacerbating the problem, making it harder for women in these areas to access the prenatal and emergency care they need. This has led to higher rates of complications, preterm births, and poorer health outcomes, particularly for Black and Indigenous women.
The consequences of living in a maternity care desert are starkly illustrated by the story of Ashley O’Neil, who experienced tragic complications during both of her pregnancies in rural southern Maryland. Her first son was born prematurely at 21 weeks and did not survive, in part because the nearest hospital capable of providing the necessary care was two hours away. Her second son, Kolin, was born at 25 weeks and faced delays in being transferred to a specialized neonatal care unit due to the lack of immediate resources and approval from insurance providers. These experiences highlight the critical need for better access to quality maternity care in rural areas.
Women living in maternity care deserts can take several steps to navigate the challenges. First, they should establish prenatal care early to detect complications that local hospitals may not be equipped to handle. Seeking out local pregnancy care centers, health clinics, or family practitioners offering maternity services is essential. Federal and state programs like WIC, TANF, and Medicaid can help with healthcare costs and referrals.
It’s important to ask questions during prenatal appointments about delivery options, complications, and emergency care logistics. Planning for transportation is also crucial, as many rural areas face travel challenges. For those without access to in-person prenatal classes, online resources can help prepare for labor and delivery.
Midwives, especially for low-risk pregnancies, can be a good option, as they may provide care in health centers rather than hospitals. Doulas can offer emotional and physical support during labor, improving outcomes. Self-advocacy is key—women should learn the signs of complications and communicate concerns with healthcare providers to ensure early intervention.
The situation of maternity care deserts is unlikely to improve without systemic changes, as rural hospitals close due to financial and staffing challenges. However, healthcare professionals in these areas remain dedicated to providing the best care possible. Despite these challenges, women must proactively seek out resources, advocate for their needs, and ensure the best outcomes for themselves and their babies.
Other ways to find care:
Federally funded health centers – These centers offer various types of care, including maternity services, for underserved communities.
March of Dimes – Their Mom & Baby Mobile Health Centers provide healthcare access to women and children in areas with limited or no maternity care.
Insurance providers – Your private insurance, Medicaid, or CHIP can provide lists of participating prenatal care providers in your area.
FindHelp.org – Use your zip code on FindHelp.org to access a directory of community-based organizations that offer free or reduced-cost resources, including healthcare, food, and housing.
