Why 7 Million Women Don’t Have Access to the Maternity Care They Need

According to a report by The March of Dimes, millions of American women don’t have access to the maternity care they need. This is partly because 7 million women of childbearing age (19-64) live in maternity deserts—counties where access to maternity healthcare services is limited or absent, either through lack of services or barriers to a woman’s ability to access that care. A staggering 10 percent of births nationwide occur in these counties, where a lack of care leads to poor maternal health outcomes and rising maternal mortality rates.

The three main factors contributing to maternity deserts across the US include:

• Lack of access to hospitals with obstetric care or birth centers. Rural counties are less likely (37.6 percent) than urban counties (58 percent) to have a hospital providing obstetric care. Unfortunately, these numbers only seem to be getting worse as more and more rural hospitals close due to higher rates of uninsured patients and large amounts of uncompensated care.
• Limited or no access to obstetric providers, midwives or doulas. Approximately half of all counties in the US lack a single obstetrician, leading to access inequities in certain communities such as rural counties. It’s estimated that fewer than 10 percent of obstetric providers practice in rural areas.
• Inadequate or no health insurance. Although the rate of uninsured women ages 19 to 64 has declined since the passage of the Affordable Care Act, about 1 in 10 or 11 percent of women in the US still did not have health insurance in 2018

Because of these factors, the absence of preventive, prenatal and postpartum care dramatically contributes to poor maternal health outcomes. There’s evidence that adequate prenatal care beginning in the first trimester can decrease the likelihood of adverse birth outcomes. Women who do not receive prenatal care are also 3 to 4 times more likely to have a pregnancy-related death than women who receive any prenatal care.

So what can we do to eliminate maternity care deserts and increase quality care in the US?

Some of the solutions March of Dimes suggests include:

1. Implement perinatal regionalization, a strategy to improve both maternal and neonatal outcomes. By coordinating a system of care within a geographic area, pregnant women would receive risk-appropriate care in a facility equipped with the proper resources and health care providers.
2. Expand Medicaid and extend Medicaid postpartum coverage to 12 months. Research shows that states that expand Medicaid improve the health of women of childbearing age by increasing access to preventive care, reducing adverse health outcomes before, during and after pregnancies, and further reducing maternal mortality rates.
3. Increase access to midwives. Access to midwives can help improve access to maternity care in under-served areas, reduce interventions that contribute to maternal mortality, lower costs and improve the health of moms and babies.
4. Reimbursement for doula care. Support increased access to doula care as one tool to help improve birth outcomes and reduce the higher rates of maternal morbidity and mortality among women of color in the US.
5. Provide coverage for telehealth services for pregnant and postpartum women. If women can’t travel to locations with maternity care, telehealth care provides a valuable way to bring the care to them.

Outside of these actions, March of Dimes adds that paid family leave, implicit bias education, and more research are all needed to address poor maternal health outcomes. Learn more about how you can advocate for maternal health policies and check out organizations like the Chamber of Mothers and MomsRising, which are dedicated to advancing mothers’ rights.