In recent years, maternity wings[2] in the U.S. have been closing at alarming rates. Since 2018, approximately 300 maternity wings have closed their doors, leaving communities with fewer options for prenatal care, delivery, and postpartum care. People living in areas with no access to maternity care are said to live in “maternity care deserts.” Nationwide, approximately 2 million birthing people live in maternity care deserts, and an additional 3.5 million live in counties with one or fewer hospitals or birth centers that provide obstetric care.While maternity care deserts exist across the U.S., they are particularly common in rural communities, especially in Southern states. The lack of access to maternity care in the South has resulted in some of the highest rates of preventable pregnancy-related deaths nationwide. Additionally, the region’s inconsistent policies, specifically pertaining to abortion and Medicaid expansion, exacerbate the effects of the maternity care deserts by further limiting access to essential care.
There are a variety of reasons for maternity wing closures, including declining birth rates and staffing shortages. Hospitals have also shared concerns about inadequate reimbursement from Medicaid, which funds 41% of all U.S. births. In some hospitals, more lucrative services like neonatal intensive care units (NICUs) help supplement the financial losses from Medicaid births. However, many hospitals, especially rural hospitals, lack NICUs. These converging financial pressures have pushed many hospitals to close their maternity wings, sometimes in order to keep the rest of the hospital open.
Without maternity wings, OB-GYNs, nurses, and midwives are forced to leave rural communities. This compounds the ongoing exodus of these providers from states that have restricted abortion post-Dobbs. These abortion bans are especially prevalent in the South, which already had high concentrations of maternity care deserts pre-Dobbs. The lack of employment opportunities for maternity providers and hostile political climate have helped further perpetuate provider shortages, making this critical care increasingly inaccessible for many.
The abortion bans in the Southern states also mean that more unwanted pregnancies are being carried to term. Not only are these individuals denied abortions, but they sometimes cannot access prenatal care once they are forced to keep their pregnancies. These individuals are said to live in a “double desert.” Approximately 3.7 million birthing people in the U.S. live in double deserts, with the largest concentration being in the South. This has had a devastating impact on communities, resulting in more preterm births. The connection between abortion care and maternity care is clear. While a few policymakers have supported efforts to expand the social safety net through programs like Temporary Assistance for Needy Families to financially support new parents in the wake of eliminating abortion access, these efforts have largely not gone anywhere. Further, these efforts do not address the specific needs of those who now live in double deserts.
Maternity wing closures also create several pressing health equity concerns. The shortage of facilities and providers has left many birthing people with no choice but to drive over 40 minutes to access maternity care. Some pregnant people are even temporarily relocating in order to be closer to their maternity provider. Obviously, temporary relocation is not something everyone can afford to do. Geographic isolation from comprehensive care increases the risk of complications and death. Many low-income birthing people do not have reliable transportation or the financial resources to drive long distances to and from appointments. One pregnant woman shared her difficult experience of having to decide whether to spend money on gas to get to and from her prenatal care appointments or pay her other bills. She is not alone.
These closures have also disproportionately impacted Black, Indigenous, and other People of Color (BIPOC) birthing people, who often experience adverse birth outcomes, including death, due to inadequate pregnancy care, racism, and chronic stress caused by racism and discrimination. This is especially true in the South. The CDC has reported that Black birthing people are almost three times more likely to die from pregnancy-related causes than their white counterparts. While the White House has initiated a response to this health equity crisis, efforts to address maternity care deserts have largely bypassed Black, rural, Southern birthing people. Policymakers must be more intentional about addressing maternity care deserts through an intersectional lens – that is, taking into account all of the different ways in which a birthing person may be affected by a lack of access to maternity care. This framework would force policymakers to take into account not only gender and geography, but also ethnicity and income, to more holistically address this crisis.
The urgency of maternity wing closures cannot be overstated. These closures are perpetuating inequities among birthing people and negatively impacting already dismal birth outcomes nationwide. This is especially true of Southern states which are often impacted not only by maternity care deserts, but also by abortion bans which further hinder access to care. Policymakers must take necessary steps to ensure that all birthing people have access to comprehensive and convenient maternity care.
[1] Cheyenne Peters (she/her) was a legal intern at the National Health Law Program in summer 2024. She is currently a 3L at the University of Tennessee College of Law.
[2] NHeLP strives to use gender inclusive language to accurately reflect the scope of people with various pregnancy care needs and related experiences. We employ “maternity care” in instances when necessary to accurately reference legal terms or cisgender women-centered research and to honor how advocates or groups self-identify. More inclusive policy language and research is needed to better service the needs of all people who need equitable access to pregnancy care.
