A significant portion of U.S. counties, more than one-third, lack access to essential obstetric and gynecological (ob-gyn) providers or labor and delivery units, according to a recent March of Dimes report. This scarcity of maternity care services creates "maternity care deserts," disproportionately affecting rural communities.
The challenges contributing to the establishment of maternity care deserts are multifaceted. Ob-gyn services can be a financial strain on hospitals, as they require constant staffing by medical professionals, including anesthesiologists, regardless of patient volume. In rural areas with lower birth rates, hospitals must maintain these costly obstetric units even when revenue generated from births is limited. Compounding this issue, rural areas often have a higher proportion of patients covered by Medicaid. This means that hospitals receive lower reimbursement rates for services, creating a "double whammy" where low patient volume is combined with reduced payment per patient, as noted in analysis from the National Partnership for Women and Families.
This situation places rural hospitals in a precarious financial position, with a 2025 analysis indicating that 131 rural hospitals with existing labor and delivery units were at risk of closure or significant service reductions. The lack of adequate reimbursement and low birth volumes make it difficult for these facilities to sustain essential maternity care services.