March of Dimes: 1 in 3 US counties remain maternity care deserts

One in 3 counties in the United States remain classified as maternity care deserts, home to 2.4 million women of reproductive age, as at least 96 labor and delivery unit closures have been reported across 35 states since January 2024, according to the “Nowhere to Go: Maternity Care Deserts Across the U.S.” 2026 report released by March of Dimes.^1,2

March of Dimes defines maternity care deserts as counties with no obstetric clinicians or birthing facilities. The 2026 report examines access to maternity care using county-level analyses of obstetric clinicians, birthing facilities, insurance coverage, and travel burden, and explores how workforce shortages, hospital closures, and policy changes are reshaping the maternity care landscape.¹

Women living in maternity care deserts travel approximately 3 times farther, on average, to reach labor and delivery services than those in counties with full access, with those added travel distances associated with delayed prenatal care entry, higher rates of unplanned out-of-hospital deliveries, increased maternal morbidity, and greater NICU admissions.²

“Across the country, families continue to face unnecessary barriers to maternity care with shifting healthcare and policy decisions threatening to widen gaps and weaken essential services,” said Cindy Rahman, President and CEO of March of Dimes. “Now is the time to reimagine what maternity care can and should be by building a system that creates healthier beginnings, stronger communities, and better outcomes for generations to come.”²

How widespread are maternity care deserts in the United States?

The 34.6% of US counties designated as maternity care deserts mirrors the share reported in the 2024 edition of the report, indicating the problem has remained largely unchanged since 2016.^1,2 Those counties account for 149,000 infant births annually, and an additional 3.4 million women and 209,000 infants live in counties with low or moderate access to maternity care. This brings the total with limited access to 5.8 million women and 358,000 infants.^1,2

More than half of counties in the United States lack a hospital with labor and delivery services, affecting nearly 370,000 births annually.² Obstetric clinician shortages are significantly more pronounced in rural areas, where nearly 58% of counties lack obstetric clinicians, compared with approximately 19% of urban counties.^1,2 About 1 in 9 women of reproductive age are uninsured nationally, with the highest rates concentrated in the South, rural areas, and maternity care deserts, according to March of Dimes.^1,2

What is driving the accelerating loss of birthing services?

From January 2024 to May 2026, at least 96 publicly reported labor and delivery unit closures were identified across 91 counties in 35 states. Of these, 60% occurred in counties where the closed unit was the only local birthing facility.^1,2 Recent closures increased travel times by an average of 25 minutes in affected communities, with increases of up to 77 additional minutes in some areas.¹ The primary reported drivers of closure were declining birth volume, workforce shortages, and financial pressure.¹

“This year’s report is a stark reminder that maternity care deserts don’t happen by chance but are the result of deliberate policy choices that have left too many families without access to essential care,” said Michael Warren, MD, MPH, FAAP, Chief Medical and Health Officer, March of Dimes.²

The report also flags insurance coverage erosion as a compounding threat. While the Affordable Care Act reduced uninsured rates among women ages 19 to 54 by 45% nationally since 2010, that reduction was only 35% in states that have not expanded Medicaid.^1,2 Proposed and enacted changes under House Resolution 1, including Medicaid funding cuts and the introduction of work requirements, threaten to reverse those gains and “increase the number of uninsured families,” according to the report.¹

What solutions is March of Dimes advancing?

The organization outlined several coordinated strategies for improving access, including advocacy for federal and state legislation protecting and expanding coverage, and support for the Rural Obstetrics Readiness Act recently reintroduced in Congress, which would fund provider training for obstetric emergencies.²

Seven March of Dimes Mom & Baby Mobile Health Centers are currently operating across the US, with 4 additional units planned for Central Alabama, Chicago, Cleveland, and Northern Arizona.² The organization is also expanding doula workforce development through a 5-year initiative with the CVS Health Foundation and piloting guaranteed income programs in New Orleans, Atlanta, and Michigan to address social determinants affecting maternal health.²

“The health of moms and babies depends on the strength of the systems that support them, and that system is currently failing us,” added Warren. “However, the solutions are within reach, and they require coordinated action from healthcare providers, policymakers, employers, and communities. We cannot solve this crisis alone."¹

References:

1. Stoneburner A, Chestnut JF, Lucas R, Jones EE, DeMaria AL. “Nowhere to Go: Maternity Care Deserts Across the U.S.” Report No. 5. March of Dimes, 2026. https://www.marchofdimes.org/maternity-care-deserts-report
2. March of Dimes. March of Dimes report reveals persistent gaps in access to maternity care as recent healthcare changes threaten an already fragile system. Press release. Published 2026.