Rural Communities and the Reproductive Healthcare Desert Crisis

By Emily Song

08/01/25

Millions of women in the United States face pregnancy without access to even the most basic maternal health services. Maternity care deserts are defined as counties with no hospitals offering obstetric services, no birth centers, and no practicing obstetricians, gynecologists, or certified nurse midwives. Impacted areas have grown into a silent public health emergency in the United States. According to the March of Dimes 2023 Maternity Care Deserts Report, over 1,100 U.S. counties, more than 35% of the country, are classified as maternity care deserts. In 2022, this lack of access has impacted over 2.3 million women of reproductive age and roughly 150,000 births, which resulted in patients facing long travel times, delayed care, or worse- no care at all. 

Do you live in a maternity care desert? Map courtesy of March of Dimes

The consequences of maternity care deserts are deadly. From 2020 to 2022, counties with little to no maternity care infrastructure saw over 10,000 excess preterm births. Preterm births are a leading cause of infant mortality and long-term health complications, yet are often preventable with timely, accessible prenatal care.

The outcomes caused by maternal healthcare deserts are particularly devastating for Black women, who already face deep structural inequities in the healthcare system. In 2022, “the maternal mortality rate for Black women was 2.6 times higher than that of White women” (Adashi, E. Y., et al, 2025). Published by the Rural Health Information Hub, The Rural Maternal Health Guide,  shows that women in rural areas are more likely to experience complications and receive inadequate care, due in part to geographic isolation and the closure of rural hospitals. The maternity desert crisis is rapidly unfolding alongside worsening abortion restrictions, eroding life-saving reproductive healthcare infrastructure. Between 2014 and 2018,  states with the most restrictive abortion laws had a 16% increase in infant mortality (Gemmill, A. et al., 2024). In Texas, following the passage of the 2021 Heartbeat Act, which banned abortions after 6 weeks, infant deaths rose by 12.8%, according to a study published in 2024 (Gemmill, A., et al.,  2024).

Since the Supreme Court’s decision in Dobbs v Jackson Women’s Health Organization, 13 states have enacted total abortion bans, and six more have implemented bans after 15 weeks (Wells, M., et al., 2024). Experts warn that while the full effects of these bans may take years to manifest, early indicators point to a further breakdown of maternal health systems, especially those in already underserved areas. Meanwhile, the United States continues to have the highest maternal mortality rate among all high-income countries- a rate that increased from 20.1 to 32.9 deaths per 100,000 live births between 2019 and 2021 before the overturning of Dobbs (Fontenot, J., et al., 2024).

 The vast majority of deaths are preventable with adequate prenatal and postnatal care, yet with increasing legal risks, more providers are leaving states with abortion bans, declining to offer emergency maternal care and/or transferring patients out of state to avoid criminal penalties. These losses are concentrated in Black, Indigenous, and rural communities, where structural inequalities- such as lack of insurance, provider bias, and limited access to culturally competent care- already place women at risk (Fontenot, J., et al., 2024).

The growing maternity healthcare desert crisis is not only a reproductive health issue; it’s a civil rights and health equity issue. Without immediate intervention, maternity care deserts will continue to expand, leaving millions without the support they need to safely bring life into the world.

References:

Adashi, E. Y., O’Mahony, D. P., & Cohen, I. G. (2025, May 12). Maternity Care Deserts: Key drivers of the National Maternal Health Crisis. Journal of the American Board of Family Medicine : JABFM. https://pmc.ncbi.nlm.nih.gov/articles/PMC12096371/ 

Burdick, K. J., Coughlin, C. G., Ambrosi, G. R., Economy, K. E., Mannix, R. C., & Lee, L. K. (2024, March). Abortion restrictiveness and infant mortality: An ecologic study, 2014-2018 - American journal of preventive medicine. https://www.ajpmonline.org/article/S0749-3797(23)00408-7/fulltext 

Fontenot, J., Brigance, C., Lucas, R., & Stoneburner, A. (2024, May 8). Navigating geographical disparities: Access to obstetric hospitals in Maternity Care Deserts and across the United States. BMC pregnancy and childbirth. https://pmc.ncbi.nlm.nih.gov/articles/PMC11080172/ 

Gemmill A, Margerison CE, Stuart EA, Bell SO. (2024, June24). Infant Deaths After Texas’ 2021 Ban on Abortion in Early Pregnancy. JAMA Pediatrics.  https://jamanetwork.com/journals/jamapediatrics/fullarticle/2819785

Gleeson, D. E., Busch, S. H., & Ichovics`, J. R. (2025, May 3). State-level prevalence of maternity care deserts: Association with Healthcare Access, Utilization, and outcomes among Medicaid recipients. AJPM Focus. https://www.sciencedirect.com/science/article/pii/S2773065425000501 

Rural Maternal Health Overview - Rural Health Information Hub. Overview - Rural Health Information Hub. (n.d.). https://www.ruralhealthinfo.org/topics/maternal-health 

Stoneburner A, Lucas R, Fontenot J, Brigance C, Jones E, DeMaria AL. Nowhere to Go: Maternity Care Deserts Across the US. (Report No 4). March of Dimes. 2024. https://www.marchofdimes.org/ maternity-care-deserts-report   

Wells, M., Conrad, C., & Taylor, K. (2024, August 3). The growing crisis of maternity care deserts. The Regulatory Review. https://www.theregreview.org/2024/08/03/the-growing-crisis-of-maternity-care-deserts/

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