Maternity Care Deserts: A Puzzling Problem in the World’s Richest Nation

What is Maternity Desert?

A maternity care desert is an area that has no obstetrics clinicians or birthing facilities. This issue is part of a broader, spiraling rural healthcare crisis that has led to 200 hospitals closing, in whole or in part, since 2005. 

The issue has worsened over the past twenty years, driven by multiple contributing factors. The lack of access to care is especially concerning when you place it in the context of the US’s poor maternal and infant health outcomes that have been worsening for years, which are the worst in the industrialized world. March of Dimes released its new report, “Nowhere To Go: Maternity Care Deserts Across the US,” in August of 2026, and what it showed was deeply concerning: 

• More than 50 percent of US counties lack a hospital with labor and delivery services 
• Ninety-six labor and delivery units closed across 35 states between 2024 and 2026
• Nearly six million women and 358,000 infants have limited access to maternity care nationwide
• Residents in these care deserts travel 3x longer to reach birth services 
• Nearly two out of three maternal deaths in the US occur in the postpartum period 
• The US has the least support for women in the postpartum period, such as home visits or guaranteed paid maternal leave, which are common in other industrialized nations

Racist Historical Origins Worsened by Modern Politics

While many of the healthcare policies discussed so far developed in the recent past, some experts say other foundational issues require looking further back in history. In particular, it’s important to look back to the early 1900s, when the modern healthcare establishment was taking shape in the US.

First, it’s crucial to understand that, for most of history, midwives oversaw births. Women who learned the art and science of assisting in childbirth from more experienced instructors. This was true in the US as well, until physicians decided they threatened their business. “For a long time, Black enslaved women–known as granny midwives–served as midwives both for the Black women in their community, as well as poor white women in rural America. They delivered the majority of babies in rural areas,” Dowd says. 

In 1908, the Carnegie Foundation for the Advancement of Teaching hired former high school teacher Abraham Flexner to audit all medical schools across the country and make recommendations. The report was a scathing rebuke of countless institutions that Flexner believed were subpar and recommended standardizing U.S. medical education. 

After the Flexner report was published in 1910, its impacts were significant and far-reaching. Many medical schools closed, higher educational standards were implemented, and a more standardized curriculum began to take shape. 

But the report’s impact didn’t end there. Flexner, like most white professionals of the day, harbored deeply racist and sexist views, and the report also resulted in five of the seven Black medical schools in the country being closed. The report also recommended that Black doctors have their education limited to hygiene only and for women to be excluded from medical education altogether. This one report resulted in Black men and women being pushed out of the medical field for decades. 

It also spawned a whole movement in medical education that reverberated through many professions for the next century. Empowered by this movement, the field of obstetrics and gynecology set its sights on the group it viewed as enemy number one: granny midwives. 

In 1915, the American Journal of Obstetrics and Gynecology launched a smear campaign against Black midwives, accusing them of being “dirty,” “superstitious,” and “incompetent.” This effort continued unchecked for decades, and by the 1970s, nearly all Black midwives had been forced out of practice and replaced with a small number of white midwives, a group that had demonstrated total fealty to the medical model and was completely fine with their position of subservience to the white male doctors.  

The State of Midwifery Today

While it’s clear that the causes of maternity care deserts are multi-factorial and require a multi-pronged approach (chiefly switching to a Universal Healthcare Model), the potential role of midwives as a solution to the rural care crisis should not be overlooked. “There is a lot of misogyny and racism at the root of the maternity care crisis we’re facing today,” Dowd says.  

It’s hard to argue with that, especially since developed nations worldwide use midwives at much higher rates than the US. For example, midwives deliver about half of all babies in the UK, and 75 percent of births in Denmark, Sweden, and France, compared to the mere 10 percent of midwife deliveries in the US. This is strange because certified nurse midwives have been shown to provide equal or better maternal and neonatal outcomes and quality measures than their physician counterparts. 

Despite the evidence and dire need of women and infants in maternal care deserts, the American medical establishment remains firmly in opposition to the expansion of midwifery practice because, then as now, midwives are viewed as financial competition. 

Dowd says, “In California, Midwives were not able to prescribe medication or order labs independently until 2020, when the Covid-19 pandemic led to a loosening of those restrictions. Insurance companies discriminate so much against reimbursing midwives for the care they provide. We’ve been working tirelessly on this in California, but it’s been incredibly difficult to initiate change.”