How maternity care works—and where it breaks down

A maternal care desert is a place where people who are pregnant or giving birth have a hard time getting maternity care. Sometimes there’s no hospital nearby that delivers babies. Sometimes, no OBs or midwives are practicing in the area. Sometimes prenatal or postpartum care exists, but only in limited or unreliable ways. The term doesn’t refer to one missing clinic or one closed unit. It describes a broader breakdown in how pregnancy and birth function in a community.

According to a 2024 report, more than 35% of counties in the United States are maternity care deserts—and nearly 2.3 million women of reproductive age live in maternity care deserts. Over half of the counties in the United States do not have a hospital that provides obstetric care, and over 2.5 million women of reproductive age live in a county without an obstetric clinician. 

The stats above point to a tough reality: maternal care deserts are becoming more common, not less. Nationwide, more than 400 maternity services closed between 2006 and 2020. Between March and June 2022 alone, 11 health systems announced they were closing their obstetric services, citing low birth volumes and staffing challenges. These numbers continue to decline. 

Research also shows that women in rural counties—where most maternal care deserts are located—face significantly higher risks during pregnancy and childbirth. Maternal mortality rates in rural areas are roughly 60% higher than in large metropolitan counties, where access to consistent prenatal, delivery, and postpartum care is more stable.

These patterns help explain why limited access to maternity care is linked to higher risks, including preventable complications and maternal death.

What that looks like day to day

In a maternal care desert, pregnancy care often takes more effort than it should. Appointments may require long drives. Labor and delivery may happen far from home, in hospitals that people don’t know well. Postpartum care, a critical period for detecting complications, is often delayed or missed.

For example, someone might spend hours driving to routine prenatal visits, only to have appointments rescheduled because a clinic is short-staffed. As the pregnancy progresses, that travel becomes harder to manage—especially while working, caring for other children, or dealing with pregnancy-related fatigue or complications. When labor starts, there may be little choice about where to go, even if it means delivering far from home and support systems.

In some places, care technically exists but feels fragile. Appointments book out months in advance. Providers stop accepting new patients or certain insurance plans. A single missed appointment can push care weeks behind. Getting to care means coordinating time off work, transportation, childcare, and recovery—all at once. On paper, care is there. In practice, it’s hard to hold onto.

How maternal care deserts form

Maternal care deserts don’t usually appear overnight. They develop as several different pressures stack on top of one another. A hospital might close its labor and delivery unit, especially in a rural area or a community already operating on thin margins. When that happens, remaining providers often absorb more patients, stretching schedules and resources even further.

At the same time, fewer clinicians choose to offer maternity care. The work can be demanding, on-call hours are long, and liability costs are high. As margins tighten, services are reduced—and those reductions add up over time.

Insurance policy shapes this landscape as well. Medicaid covers a large share of births (over 40% of births, including nearly 50% of births in rural communities), but coverage rules and payment rates affect whether maternity care is financially sustainable for clinics and hospitals. When margins tighten, services are scaled back. Over time, these decisions compound. What starts as longer wait times or fewer appointment slots can quietly become the complete loss of local maternity care.

Why maternal care deserts can appear quickly

Maternal care deserts aren’t always permanent, but they are often unstable. In some communities, care fades over time as providers retire, units downsize, or services are quietly consolidated elsewhere. In others, the shift is abrupt—such as when a hospital closes its labor and delivery unit with little notice, leaving patients and providers scrambling.

What makes this especially challenging is how thin the margin often is. Many maternity units rely on a small number of clinicians, limited staff coverage, and tight budgets. Small changes—like one provider leaving or a staffing shortage—can quickly destabilize care.

This means that communities with maternity care today may be closer to losing it than they realize. The difference between having local care and becoming a maternal care desert is sometimes a single staffing change or budget decision.

Healthcare coverage isn’t the same as care

Having insurance does not guarantee that maternity care is actually available. People can be fully covered and still struggle to find a provider nearby, schedule appointments in a reasonable timeframe, or access postpartum follow-up once they’ve given birth.

This often happens when there are too few providers in an area, when clinics stop accepting certain insurance plans, or when appointment availability is limited. In these situations, coverage exists on paper, but the care itself is difficult to secure. People may spend weeks calling offices, be placed on long waitlists, or be told to look elsewhere.

This gap helps explain why insurance coverage alone does not always improve outcomes. Care depends on people, facilities, and systems being in place—not just on eligibility rules or insurance cards. Without the infrastructure to deliver care, coverage cannot do the work it is meant to do.

Why “just travel to find care” is complicated

Maternal care deserts are sometimes dismissed with the assumption that people can travel to receive care. But pregnancy and childbirth don’t fit neatly into that logic. Prenatal care involves regular, ongoing visits. Labor is incredibly unpredictable. Postpartum complications often arise after someone has returned home.

Long distances make it harder to keep up with routine care and more difficult to respond quickly when something goes wrong. Travel also adds layers of coordination—time off work, transportation, childcare, and recovery—that are not available to everyone.

Distance doesn’t just add inconvenience—it shapes whether and how people receive care at all. Over time, those changes can affect both short- and long-term health outcomes.

Why this matters

Maternal care deserts change what pregnancy looks like in practice. They turn something that should be routine and supported into something uncertain, fragmented, and, in some cases, dangerous.

As these deserts expand, pregnancy in the United States becomes less predictable and more geographically dependent. Where someone lives increasingly shapes how early complications are caught, whether care is continuous, and how quickly help is available when something goes wrong.

This is why maternal care deserts matter beyond any single statistic. They reflect a system where pregnancy risks vary widely depending on where someone lives, with real consequences for women and families.