SMFM outlines strategies to expand maternal-fetal medicine access in rural and underserved communities

A new special statement from the Society for Maternal-Fetal Medicine (SMFM), published in Pregnancy, calls for targeted workforce, policy, and funding reforms to improve access to maternal-fetal medicine (MFM) care in rural and underserved communities, where shortages of subspecialty obstetrical care continue to contribute to higher rates of maternal morbidity and mortality.¹

The special statement was published just ahead of SMFM’s 2026 Pregnancy meeting, which Contemporary OB/GYN will be covering throughout the week.

Click here for direct access to our SMFM conference page.²

Access to subspecialty obstetrical care is strongly associated with improved pregnancy outcomes, including lower rates of preterm birth, cesarean delivery, and perinatal mortality. However, SMFM noted that large geographic gaps in the MFM workforce persist across the United States, particularly in rural areas, where birthing people face higher risks of severe maternal complications and death. Contemporary data show that individuals living in rural areas have a 9% higher probability of severe maternal morbidity and mortality compared to those in urban areas, a disparity driven in part by limited access to subspecialty care.¹

The statement highlights evidence demonstrating a direct relationship between MFM workforce density and maternal outcomes. In one study cited by SMFM, an increase of 5 MFM specialists per 10,000 live births was associated with a 27% reduction in maternal mortality risk. Despite this, nearly all MFM subspecialists practice in urban centers, even though more than 1 in 6 births occur in rural facilities.

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Geographic barriers extend beyond rural regions alone. SMFM emphasizes that urban maternity care deserts also pose substantial access challenges, with patients often traveling 3-times farther than those living in non-desert urban areas. Hospital closures, provider shortages, insurance barriers, and fragmented care systems all contribute to reduced access to both obstetrical and MFM services.

The statement also addresses recent policy shifts that may further strain the MFM workforce. Following the 2022 Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, MFM subspecialists and other obstetric clinicians have increasingly relocated from states with restrictive abortion policies to states with more permissive laws. These trends, combined with challenges to residency and fellowship training in restrictive states, threaten to worsen existing workforce shortages, particularly in regions that already lack adequate obstetrical care.

SMFM reviews current federal and state programs aimed at strengthening the healthcare workforce, including graduate medical education (GME) funding, rural training tracks, and loan repayment initiatives. While these programs play an important role in expanding access to care, the society noted that many incentive programs prioritize primary care clinicians and exclude MFM subspecialists, limiting their effectiveness in addressing high-risk pregnancy care gaps.

The statement also highlights the potential role of telehealth, outreach programs, and perinatal regionalization systems in extending MFM expertise to underserved areas. While telemedicine can improve access and support local care teams, SMFM emphasizes that it cannot replace the need for in-person care for pregnant patients.

Ultimately, SMFM called for coordinated policy action to expand training pathways, financial incentives, and care networks to ensure that pregnant people—regardless of geography—have access to appropriate subspecialty obstetrical care.

Below, see the recommendations from SMFM, as published in Pregnancy.

SMFM recommendations to improve maternal-fetal medicine access in rural communities

• Increase funding for federal GME programs that provide training in rural and underserved communities.

“Expanding available OBGYN training positions, specifically in underserved areas, will create a pipeline of specialists and subspecialists. To ensure funds reach communities with the most need, new funding should prioritize OBGYN residency programs in rural or underserved communities and support or incentivize MFM fellowship programs that serve maternity care deserts.

• Increase funding for existing loan forgiveness programs and expand them to include MFM subspecialists who serve rural and underserved areas.

SMFM strongly supports additional funding for federal and state loan forgiveness programs to incentivize the training of multidisciplinary teams necessary to provide quality obstetrical care to practice in rural settings. Eligibility for these programs should be expanded to include MFM physicians, who are essential to the care team for high-risk pregnant patients.

• Explore other financial incentives to encourage MFM subspecialists to serve rural and underserved settings.

Policymakers should develop and test innovative programs to incentivize high-risk pregnancy clinicians to care for individuals living in rural and underserved communities. Possibilities include, but are not limited to, tax credits, liability insurance assistance, and payment incentives through government insurance programs.

• Scale and expand programs successfully providing care to high-risk pregnant patients and disseminate best practices.

SMFM supports increased investment in programs focused on enhancing care for high-risk patients living in rural or underserved settings. We encourage federal and state governments to expand programs that are working and encourage these governments to work with professional organizations, including SMFM, to share successful programs that can be adapted for other underserved regions.

• Implement robust perinatal regionalization systems.

Perinatal regionalization promises to appropriately distribute finite maternity care providers and resources across a region or state, ensuring high-risk pregnant patients living in rural areas receive the higher level of care needed to protect their health and the health of their infants. This care includes access not only to MFM services but also to the full team of necessary maternity care clinicians and allied health professionals, including advanced practice clinicians, sonographers, diabetes educators, and genetic counselors. Included in this effort is the goal of optimizing the appropriate utilization of MFM specialists and distributing obstetrical services among appropriate-level providers.

• Establish out-of-state care networks for individuals living in maternity care deserts.

Given that the closest MFM physician or risk-appropriate labor and delivery unit for a patient can be in a neighboring state, states should explore opportunities to approve out-of-state clinicians and birthing facilities as Medicaid providers. This approach would allow the state to reimburse for transport, care, and delivery closer to the patient's community.”

References:

1. Miller HE, Yee LM, Heuser C, et al. SMFM Special Statement: Opportunities to improve access to maternal-fetal medicine care in rural and underserved communities. Pregnancy. Published February 4, 2026. Accessed February 9, 2026. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/pmf2.70211?campaign=woletoc
2. Society for Maternal-Fetal Medicine. Contemporary OB/GYN. Accessed February 9, 2026. https://www.contemporaryobgyn.net/conferences/smfm