The fact of the United States’ dire maternal health crisis is unequivocal. Today, birthing people are more likely to die of pregnancy and childbirth-related complications than those of the generation before them. What’s worse, a closer look unveils stark racial disparities in maternal deaths in the United States. At a minimum, Black and Indigenous birthing people are two to three times more likely to die of pregnancy and childbirth-related complications, with 80% of these deaths being preventable. Unfortunately, maternal health organization March of Dimes’ new collection of reports tells the story of a maternal health landscape that is worsening with time. It is our hope that by unveiling the severity of maternal health conditions as they stand, the reports will call in key players to improve conditions for birthing people in the United States.
Aptly titled Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity, March of Dimes’ collection of reports attempts to analyze maternal care access in its full scope, covering the 50 states, Washington, D.C., and Puerto Rico. Collectively, the reports show that 5.6 million birthing people in the United States live in what is known as a maternity care desert. These counties do not have a hospital or birthing center offering obstetric care, or any obstetric providers. Unfortunately, this means that families must go the extra mile—in many cases, quite literally—to access healthcare during a time that their lives, and the livelihood of their growing infants, depend on it. This is not merely a matter of inconvenience; access to maternity care is necessary for preventing poor health outcomes and bridging racial gaps in maternal mortality.
The collection presents data on several key factors working in conjunction to shape maternal health in the United States: levels of maternity care, access and maternity care deserts by county, distance to birthing hospitals, availability of family planning services, community level factors associated with prenatal care usage, and the burden and consequences of chronic health conditions across each state.
Overall, the collection shows dismal maternal health outcomes. Since their 2018 report, which also explores access to maternity care, the closure of obstetric units in hospitals has reduced maternity care access in 369 counties. In other words, since 2018, nearly 1 in 10 counties in the United States experienced a decrease in maternal health care access as a result of these closures.
An expected, yet disheartening concomitant of this decrease was a growth in maternity care desserts. According to the report, 70 additional counties have been classified as maternity care deserts since the initial report. This means that in 70 counties, birthing people are not experiencing a decrease in maternal care alone. They’ve been bereft of accessible maternal health care altogether. Without access to reproductive healthcare services, over 32-million birthing people are susceptible to poor pregnancy and childbirth outcomes.
In addition to racial disparities, the maternal health crisis speaks to vast differences in maternal health care by region. The report reveals that states with a higher percentage of rural populations, like North Dakota, South Dakota, Alaska, Oklahoma, and Nebraska, show the highest rates of maternity care deserts.
Maternity care deserts are one piece of a larger puzzle. March of Dimes underscores the contribution of pre-existing chronic conditions, socioeconomic background, and environmental factors to poor maternal health outcomes. More specifically, they point to the factors that make an event like childbirth more deadly than safe for birthing people long before they enter a hospital or birthing center. According to the report, 80 percent of maternity care deserts have a high burden of pregnant people with pre-existing chronic
health conditions, which can increase the risk for conditions like preeclampsia—one of the leading causes of maternal mortality—and preterm birth. Because of the ills of structural racism, conditions like hypertension, diabetes, and smoking are more likely to ravage underserved populations, which makes them particularly vulnerable within the sphere of maternal health. On the whole, one factor that makes the growth of maternity care deserts so troubling is their appearance in environments that are already conducive to poor maternal health outcomes.
Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity is a call to action and a reminder to policymakers that the maternal health crisis is a fight for us all. Within it is a seemingly demoralizing, yet galvanizing message—our current efforts to improve maternal health outcomes in the United States are not enough because we do not understand the extent of the problem. By revealing where our collective efforts are best-served and encouraging intentional action, the report will assist in creating better realities for birthing people everywhere.
Access the report here.
About March of Dimes
March of Dimes leads the fight for the health of all moms and babies. We support research, lead programs and provide education and advocacy so that every family can have the best possible start. Building on a successful 85-year legacy, we support every pregnant person and every family. To learn more about March of Dimes, please visit marchofdimes.org.