Nowhere to go: An overview of maternity care access across the U.S․

• Over 35 % of U.S. counties have no access to maternity care, affecting 2.3 million reproductive-age women. • Rural areas face maternity care access issues and 56 % of rural counties have no access to care. • Medicaid expansion improves access, but according to Census data, 11.5 % of reproductive-aged women in the U.S. remain uninsured. • Telehealth solutions show promise in improving access, outcomes, and satisfaction. • Midwifery care could improve access, but significant policy and practice barriers persist. Significant portions of the U.S. population face barriers to maternity care, contributing to rising rates of maternal and infant morbidity and mortality, particularly among rural and historically marginalized communities. Over 35 % of U.S. counties are designated as “maternity care deserts”, lacking obstetric clinicians and birthing facilities. These counties are home to more than 2.3 million reproductive-aged women and account for over 150,000 births annually. Limited access to maternity care is associated with delayed prenatal care, increased preterm birth rates, and higher maternal mortality. Contributing factors include hospital closures, clinician shortages, restrictive policies, and gaps in insurance coverage, disproportionately affecting Medicaid recipients and communities of color. Addressing this crisis requires multifaceted policy solutions. Expanding Medicaid coverage and increasing payment rates can incentivize provider participation and reduce financial barriers to care. Integrating midwifery care offers safe, patient-centered options for low-risk births, yet restrictive state policies and limited training opportunities hinder growth in this workforce. Telehealth presents a promising approach to extending access, particularly in rural areas, by enabling remote consultations, monitoring, and perinatal education. Additionally, fostering regionalized perinatal care networks and investing in workforce development are critical to strengthening the maternity care system. Action is needed to close persistent gaps in maternity care access and ensure equitable, high-quality care for all birthing people. Policymakers, clinicians, and advocates must implement evidence-based solutions to mitigate disparities and improve maternal and infant health outcomes across the U.S.