US Faces Maternity Health Crisis as Access to Care Diminishes
The United States is grappling with a significant maternity health crisis, as a recent report reveals that 1 in every 3 counties lacks a single obstetric clinician, severely impacting women’s access to care. The report, released Tuesday by the maternal and infant health nonprofit March of Dimes, highlights that many obstetricians and family physicians delivering babies are exiting the workforce, exacerbating the issue.
In 2022, more than 85% of babies delivered nationwide were born to ob/gyns. However, projections from the American College of Obstetricians and Gynecologists (ACOG) indicate a potential shortage of 12,000 to 15,000 ob/gyns by 2050.
Dr. Amanda Williams, the interim chief medical officer for March of Dimes, noted, “There’s been a significant uptick in, say, the last five years in terms of hospitals closing their obstetric units, with staff shortages, poor reimbursements, low birth volumes, all of those are influencing the hospital’s decision to close obstetric units and leaving patients with very limited choices about where they can have their delivery.”
She highlighted that post-pandemic staffing shortages greatly affect healthcare, stating, “We know that, especially following the pandemic, there are many staffing shortages, particularly in nursing. And then we have shortages of ob/gyns and family practice doctors and midwives who could be taking on more of the burden.”
In some regions where access to ob/gyns is limited, family physicians have stepped in to provide maternity care. The report found that family physicians make up 1 in 4 obstetric clinicians in rural counties, as opposed to only 1 in 20 in urban settings. Furthermore, family physicians in rural areas are more likely to report delivering babies compared to their urban counterparts.
The report also addresses the impact of the US Supreme Court’s Dobbs decision, which overturned Roe v. Wade in 2022, on the training and delivery methods for ob/gyns. The report notes, “In states with the most restrictive abortion laws, physicians face severe consequences, including the potential risks of losing their medical licenses and imprisonment for providing abortions, including ones that are medically necessary.”
Data from 2021 demonstrated that states where abortion is now prohibited have a lower number of ob/gyns per 10,000 births compared to states where abortion rights are protected. Dr. Williams added, “In those states that have the strictest abortion bans, there are an increased number of providers who say that it is changing the way that they’re able to take care of their patients.”
Overall, the report indicates that over 35% of US counties are classified as “maternity care deserts” due to limited or nonexistent access to maternity care services. Specifically, in 1,104 counties, there are no birthing facilities or obstetric clinicians, affecting more than 2.3 million women of reproductive age. In 2022, women in these counties gave birth to over 150,000 babies. Living in a maternity care desert correlates with a 13% increased risk of preterm birth, with approximately 60% of these deserts situated in rural areas.
ACOG President Dr. Stella Dantas expressed concern about the growing number of maternity care deserts, stating that as hospitals continue to eliminate obstetric services due to financial strains tied to the COVID-19 pandemic and other factors, the situation is becoming increasingly dire.
Dantas highlighted the importance of advocating for improved reimbursements and reduced administrative burdens, stating, “This is why ACOG has made it a priority to advance policies that support training and education for nonobstetric health care professionals in a variety of settings.”
Dr. Dantas also mentioned that ACOG is collaborating with the US Centers for Disease Control and Prevention (CDC) and the federal Health Resources and Services Administration to enhance resources for medical facilities and practitioners in rural areas to manage pregnancy-related emergencies effectively.
The Dobbs decision is “likely playing a major role” in the declining ob/gyn workforce in rural areas, Dantas noted, emphasizing the need to combat legislative interference in medical practice to ensure clinicians can operate freely and patients receive necessary care within their communities.
States reporting the highest percentage of maternity care deserts include North Dakota (73.6%), South Dakota (57.6%), Oklahoma (51.9%), Missouri (51.6%), Nebraska (51.3%), and Arkansas (50.7%).
Additionally, the report states that, on average, women giving birth in the US travel approximately 16 minutes by car to reach their nearest birthing hospital; however, that time increases to about 38 minutes for residents in maternity care deserts and roughly 26 minutes for rural inhabitants.
Dr. Williams commented on the significance of the new report, stating, “What’s different about this report is that we can now see the impact of the maternity care deserts. We can see that families who live in maternity care deserts are traveling 2.6 times longer to reach a birthing hospital.”
The March of Dimes report revealed that over half (52%) of US counties lack a hospital providing obstetric care, and between 2021 and 2022, about 1 in 25 obstetric units closed nationwide. In 2022, although 97.7% of births in the US occurred in hospitals, nearly 6 million women of reproductive age—equating to 1 in 10 babies born—resided in areas without hospital obstetric services.
Despite this crisis, there has been a notable rise in the use of birth centers, which provide maternity care services outside of traditional hospital settings. The number of births that took place in birth centers grew from 19,878 in 2017 to 23,945 in 2022.
Currently, there are 416 licensed birth centers spanning 270 counties nationwide, but fewer than 5% are located in rural areas, with 70% situated in just 10 states, including Arizona, California, and Florida. Dr. Williams emphasized the potential of birth centers to address care gaps for low-risk patients, highlighting their feasibility as a viable solution in communities lacking hospital resources.
To improve maternity care access, March of Dimes advocates for expanded training opportunities for midwives and investments in telehealth services. “We need to expand our ability to take care of patients, and low-risk patients really are best taken care of by the experts in physiologic birth, and that is midwifery care,” Williams stated.
She noted that only about 10% of births in the United States are attended by midwives, a stark contrast to many European countries where the majority of births involve midwifery care, correlating with lower maternal mortality rates and reduced C-section and preterm birth rates.
Dr. Georges Benjamin, executive director of the American Public Health Association, characterized the findings of the March of Dimes report as “quite frightening,” emphasizing the systemic failures resulting from the underfunding of the public health infrastructure in the country. He remarked, “This brings into great clarity the failure of the lack of more concrete health system planning.”
Benjamin further explained, “When you look at where these holes in maternity care are in our system, it’s in the same part of our nation that also has inadequate access to health care for health insurance, highest morbidity and mortality for chronic diseases, which is primarily in the South and parts of the midwestern part of the nation. We have an enormous lack of health system planning and policies to ensure that people have access to care.”