In addition to stark disparities in maternal health outcomes, the U.S. is seeing a rise in the number of maternity care deserts nationwide. Between 2006 and 2020, more than 400 maternity wards closed across the country in both rural and urban areas, with more closures reported in subsequent years. As of 2024, over half of U.S. counties do not have a hospital that provides maternity care, leaving over 2 million women of reproductive age living in a maternity care desert.

Beyond maternity unit closures, factors such as workforce shortages, shifts in care delivery models, and cost-cutting measures have further diminished access to quality maternity care, contributing to worsening maternal health outcomes and an increase in prevalence of maternity care deserts.

Addressing the root causes of maternity care deserts is critical for reducing the maternal mortality rate and improving pregnancy-related health outcomes. During NASHP’s 2024 Annual Conference session “Country (and City) Roads: Addressing Maternity Care and Pediatric Specialty Care Deserts,” state officials and health services researchers highlighted innovations and strategies for closing the gap in access to quality maternity care. Examples of state policy strategies discussed during the session included:

• Mapping maternity care services and providers across the state to best understand gaps and capabilities of the existing perinatal health care system
• Leveraging alternative delivery modalities, such as mobile maternity care units or telehealth, to improve access to prenatal and postpartum care services
• Assessing state network adequacy standards for perinatal care to identify needs in areas with longer distances to care
• Defining levels of care through perinatal regionalization to ensure facilities are equipped to deliver care appropriate for individual medical needs
• Strengthening hospital finances through different funding and reimbursement models to prevent further maternity unit closers, particularly in rural hospitals
• Expanding state provider scope of practice laws to increase the number of maternity care providers
• Leveraging and maximizing the postpartum coverage extension under Medicaid to ensure coverage through 12 months postpartum

As maternity care deserts continue to impact maternal health outcomes, states have the opportunity to implement policy strategies that can improve access to quality maternity care services and providers. NASHP will continue to work with and support states as they seek to better understand the impact on pregnant individuals, particularly those who are most vulnerable to restricted access to care, and advance policy innovations to address maternity care deserts.