One in Three US Counties Has No Birth Hospital or OB
According to the March of Dimes 2024 Maternity Care Deserts report, 35% of US counties are classified as “maternity care deserts” — areas with no hospital offering obstetric care, no birth center, and no obstetric clinician. More than 2.3 million women of childbearing age live in these counties.
What Counts as a Maternity Care Desert?
The March of Dimes defines a maternity care desert as any county that has no hospital offering obstetric care, no birth center, and no obstetric clinician. Beyond full deserts, an additional 36% of counties have “low access” to maternity care.
Why Is This Happening?
Hospital labor and delivery units are among the least profitable services hospitals can offer. Between 2004 and 2020, over 300 rural hospitals closed their L&D units.
Contributing factors include low Medicare/Medicaid reimbursement rates, high malpractice insurance costs, declining rural birth rates, and a shortage of obstetric providers.
What It Means for Expectant Mothers
If you live in or near a maternity care desert:
- Plan your travel early — identify the nearest hospital with L&D and practice the route
- Consider your birth timing — weather, road conditions, and distance matter at 3am in labor
- Ask about telehealth prenatal care — many rural areas now have OB telehealth programs
- Consider a birth center — a safe alternative for low-risk pregnancies
- Hire a doula — a trained birth professional can help navigate emergencies
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