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Multiple reports have highlighted how the U.S. is not up-to-par with other developed countries when it comes to maternity care. The Organization for Economic Co-operation and Development (OECD) ranks the U.S. 33^rd out of its 36 members in infant mortality rates. Demographic changes, dropping birthrates and low payment reimbursements are leading to more maternity ward closures – leaving large swaths of our country without access to care. Keep reading to learn more about maternity care deserts, the impact they will have on our populous, and key policies to improve maternal care. “Desertification” is spreading… Our nation is undergoing demographic shifts that are impacting the vitality of maternity care:

• More families are leaving northern and western regions for the south. Similarly, urban and suburbanization are pulling people away from rural areas, causing some areas to experience population booms while others see decreases.
• The dropping national birthrate reflects the reality of less babies being born nationwide.

These changes are resulting in health care providers being forced to shutter their maternity wards, which can be financially difficult to maintain. Around 370 counties have seen decreased access to maternity care services since 2018 because of obstetric unit closures. Additionally, low Medicaid reimbursement rates and staffing shortages are contributing to the decline in access. The lack of Medicaid expansion in several states has left about 2 million Americans ineligible for affordable coverage. Reduced access contributes to worse health outcomes. Maternity care deserts disproportionately harm:

• Rural communities with over 66% of maternity care deserts being found in rural counties and only 7% of obstetric providers practicing in rural areas. Rural areas are particularly impacted by this, with fewer than half of women in rural areas being able to find perinatal care within 30 miles, according to CMS. Mississippi, South Dakota and Kentucky have the highest population of people living in maternal health deserts.
• Minority groups with one in four Native American babies and one in six Black babies being born in areas with limited or no access to maternity care services. Black, Hispanic and Native American women were more likely than White women to rely on Medicaid than private insurers, underscoring the need for Medicaid expansion to grow affordable coverage.

Policy changes are needed if we want to improve access to maternal care. Medicaid policies that could help improve maternal care include raising Medicaid income eligibility thresholds for parents, increasing Medicaid payment rates for prenatal care and maternal services, extending Medicaid postpartum coverage to one year, providing coverage of midwives and doulas, improving coverage of telehealth, improving the data collection process for maternal morbidity and mortality data, and increasing funding for struggling rural hospitals.