The U.S. maternal mortality crisis is well documented, and longstanding and stark disparities in maternal health outcomes have worsened for some populations in recent years. Compounding this crisis, the U.S. has experienced an increase in maternity care deserts—places with no hospitals or birth centers offering obstetric care and no obstetric providers—in both urban and rural areas across the country. Studies show that hospital closures in both rural and urban communities can harm maternal health, worsening delivery outcomes and increasing disparities.

Many states are concerned about maternity care deserts, which could be exacerbated by further hospital closures impacted by federal funding cuts to Medicaid. NASHP is pleased to announce it is working with eight states (California, Colorado, Kentucky, Ohio, Pennsylvania, Virginia, Washington, and Wyoming) as part of a two-year policy academy, supported by the Health Resources and Services Administration, Maternal and Child Health Bureau, to provide in-depth technical assistance and support to address this critical issue.

Maternity care deserts can have serious implications for pregnant women who cannot access necessary maternity care. Geographic location can affect important factors such as access to transportation, housing, food, and health care, all of which can have an impact on maternal health outcomes.

Leading policy strategies for states to improve access to care for pregnant women living in maternity care deserts include:

• Assessing the extent of maternity care deserts through data mapping and other related strategies (e.g., data dashboards),
• Supporting new and enhanced maternity care delivery models (e.g., telehealth, mobile health units),
• Strengthening the perinatal workforce (e.g., doulas, midwives, community health workers),
• Conducting quality assurance, monitoring, and improvement to ensure high-quality perinatal care, and
• Strengthening payment and financing strategies for perinatal care (e.g., alternative payment models).

States will work in cross-sector teams with representatives from Medicaid, public health (e.g., Title V Maternal and Child Health Services programs), governor’s offices, perinatal quality collaboratives, health plans, and other state agencies and community partner organizations.

Participating states have varied goals, from tracking labor and delivery unit closures, to developing long-term plans to pilot maternity care expansion, to building regional care delivery models and adding birthing centers in areas with low or no access to maternity care. Yet, the common, collective goal across all states is to improve overall maternal health outcomes. NASHP will provide in-depth technical assistance, including peer-to-peer learning opportunities, and in-depth analyses on leading state policy innovations and strategies.

The Maternity Care Deserts Policy Academy is part of NASHP’s broader portfolio of work in supporting states to improve maternal health outcomes. NASHP’s longstanding maternal health work involves research and analyses of leading priority areas for states, including health care delivery systems, Medicaid financing, workforce considerations, and program supports. For more information about NASHP’s longstanding work in supporting states’ maternal health policies, see NASHP’s maternal health resources.