According to the March of Dimes, a health advocacy nonprofit organization, maternity care deserts are in areas “where there’s a lack of maternity care resources, where there are no hospitals or birth centers offering obstetric care and no obstetric providers.”

In these areas, it means that women do not have access to the necessary medical care during pregnancy, childbirth, and postpartum, which can pose significant risks to the health and well-being of mothers and their babies. It has become a growing concern in the U.S., affecting millions of women and leading to increased risks of harmful maternal and infant health outcomes.

According to a 2022 report published by the March of Dimes, about 7 million women and about 500,000 births are affected nationwide. The number of counties classified as maternity care deserts has jumped by two percent since 2020. The issue is particularly prevalent in states like Ohio, Alabama, and Florida.

Much of the problem is that many birthing hospitals and facilities have shut down due to a shortage of obstetric providers, among other issues. 

What's causing the shortages? For starters, the number of women requiring obstetric care has climbed significantly, with an increase of 33 million women over the age of 18 in recent decades. Yet, the number of obstetricians has not kept pace with this growing population.

The growing OB-GYN shortage is mostly a matter of demand exceeding supply. In recent decades, the number of U.S. women over age 18 has increased by 33 million — yet OB-GYN first-year residency positions grew by less than 200 between 1992 and 2016.

In addition, many OB-GYNs are nearing retirement: their average age is 51, and they tend to retire beginning at 59. Some may consider leaving in part because of their specialty’s high likelihood of being sued. In fact, nearly two out of three OB-GYNs face legal action at some point, the highest rate of all specialties, according to a 2018 report.

Another major contributor to the problem is the financial challenges faced by many hospitals that provide birthing services. Providing maternal care is expensive. But the reimbursements, particularly those coming from Medicaid, are relatively low. The "financial mismatch" poses a substantial challenge for medical facilities, especially in rural areas where a higher proportion of patients are reliant on government-provided health insurance. This has created a situation in which hospitals are struggling to maintain their obstetrics units.

One factor fueling the obstetric unit closures across the country is the financial mismatch facing hospitals — maternal care is expensive to provide and reimbursements are low, particularly from Medicaid, which pays for more than 40 percent of births. That’s a particular challenge for rural hospitals, which have a higher proportion of patients on government-run health insurance than their urban counterparts.

Another issue is widespread burnout among those in the obstetrics profession.

Long hours, midnight dashes to the hospital, and stressful emergencies all contribute to the burnout that can lead OB-GYNs to cut back on — or leave — their practices. OB-GYNs tend to experience higher rates of burnout than their peers according to a 2018 report, ranking fourth out of 29 specialties.

Saint Louis University (SLU) School of Medicine has been working to address such concerns for years. In the school’s affiliated hospitals and OB-GYN practices, faculty benefit from part-time schedules as well as nurse practitioners and midwives hired to lighten the load.

In Alabama, the situation has grown even more dire, with a significant number of counties becoming maternity care deserts due to birthing hospital closures.

In rural areas, such as Monroe County, one closing might leave an entire community without labor and delivery services. More than a third of Alabama’s counties are maternity care deserts, lacking hospitals with obstetrics care, birth centers or obstetrics providers, according to a report from the March of Dimes, a nonprofit organization.

Liz Kirby, Monroe County Hospital's CEO, said a physician shortage was behind the closing. After the Supreme Court decision overturning Roe v. Wade, some hospitals in states with strict abortion bans have warned that it could become harder to recruit OB-GYNs, though Kirby said she wasn't aware of that as a factor in this case. Residency applications for the specialty have also dropped more in states with abortion bans than nationally.

Addressing the maternity care deserts issue would require a comprehensive approach. It could require more research to understand how to integrate midwives and other professionals more fully into the healthcare system. According to Johns Hopkins Nursing magazine, prior campaigns against midwifery and government regulations have made this more difficult.

However, historical campaigns against midwifery that targeted Black and immigrant midwives in the 20th century (Goode, 2015) along with prohibitive local, hospital, state, and federal policies have prevented midwives from fully integrating into the healthcare system. This lack of integration negatively impacts outcomes, access, and quality of care (Vedam et al., 2018). Midwives provide care within a relationship-centered model that prioritizes respect, and autonomy, two crucial components of quality maternity care.

The financial problems seem to be caused mostly by state programs that are designed to ensure that those who need insurance will not have to go without. Yet, this has created even more of a problem because the decreased revenue for providers is prompting them to seek other types of work. As is typical, government involvement has only exacerbated the problems they are ostensibly intended to solve. Perhaps taking the state out of the picture altogether might be a decent start to ensuring that mothers and babies can get the help they need to protect their well-being.