Maternity Care Deserts: The Crisis of Labor and Delivery Unit Closures

Maternity care deserts are regions where pregnant people lack access to obstetric providers or hospitals with labor and delivery units. According to the March for Every Baby campaign, the closure of rural hospital units forces patients to travel long distances for prenatal and delivery care, which increases the risk of maternal and neonatal complications due to delayed emergency interventions.

The Economic Drivers of Hospital Unit Closures

Financial instability drives the shuttering of maternity wards, particularly in rural areas. According to the Kaiser Family Foundation (KFF), low reimbursement rates from Medicaid—the primary payer for many maternity patients—often make labor and delivery units unsustainable for small community hospitals. When these units close, patients must travel to larger urban hubs, creating “care deserts” where the nearest available hospital may be over 30 miles away.

The Centers for Medicare & Medicaid Services (CMS) data indicates that the high cost of maintaining 24/7 staffing for obstetricians and nursing teams, combined with rising malpractice insurance premiums, further incentivizes hospitals to consolidate services into fewer, larger regional centers.

Impact on Maternal and Infant Health Outcomes

Distance to care directly correlates with adverse health outcomes. Research published by the American College of Obstetricians and Gynecologists (ACOG) suggests that increased travel time for prenatal visits leads to higher rates of missed screenings and late-stage diagnoses of conditions like preeclampsia.

Emergency complications during labor, such as postpartum hemorrhage or fetal distress, require immediate surgical or medical intervention. When a patient is in a maternity care desert, the “transport time” to a facility capable of performing an emergency C-section can exceed the critical window for patient safety, according to reports from the Centers for Disease Control and Prevention (CDC).

Comparing Rural vs. Urban Access Gaps

The disparity in access is most pronounced when comparing geographic regions and socioeconomic status. The following table outlines the primary differences in maternity care infrastructure:

Policy Interventions and Alternative Care Models

To combat the rise of care deserts, some states are implementing alternative delivery models. The Health Resources and Services Administration (HRSA) supports the expansion of Federally Qualified Health Centers (FQHCs) to provide prenatal care, though these centers cannot perform deliveries.

Other strategies include:

• Telehealth Expansion: Using remote monitoring for high-risk pregnancies to reduce the frequency of long-distance travel.
• Midwifery Integration: Increasing the scope of practice for Certified Nurse-Midwives (CNMs) to manage low-risk births in community settings.
• Medicaid Reimbursement Reform: Proposals to increase payment rates for rural providers to make maintaining a labor unit financially viable.

Frequently Asked Questions

What defines a “maternity care desert”?

A maternity care desert is an area where a significant portion of the population lacks access to a hospital with an active labor and delivery unit or a provider of obstetric care within a reasonable driving distance, typically defined by the CDC and health advocates as lacking local access to essential obstetric services.

How does this affect mortality rates?

According to the CDC, limited access to care contributes to higher maternal mortality rates, particularly among Black and Indigenous women, who already face systemic disparities in healthcare quality and access.

Are there ways to find the nearest open unit?

Patients are encouraged to check their insurance provider directories or state health department registries, as hospital closure announcements may not always reach all patients in a timely manner.