In October 2022, the March of Dimes released an updated report on maternity care in the United States focusing on access: Nowhere to Go: Maternity Care Deserts Across the U.S. (Brigance et al., 2022). These data do not reflect favorable conditions for being pregnant, giving birth, or during the first year postpartum in our country. Access to maternity care continues to be a challenge for a significant portion of the childbearing population. "Maternity care deserts are [defined as] counties where there is a lack of maternity care resources, where there are no hospitals or birth centers offering obstetric care and no obstetric providers" (Brigance et al., 2022, p. 2) per the March of Dimes. More than 2.2 million women in the childbearing age population live in maternity care deserts and 4.7 million others live in areas with limited access to maternity care (Brigance et al., 2022).

There continues to be a mismatch between location of those needing maternity care and health care professionals who are available to provide that care. There were approximately 3,659,289 live births in the United States in 2021 (Hamilton et al., 2022). Of those, over 500,000 (~14%) were to residents of rural counties; however, only 7% of maternity care providers, including obstetricians and midwives, practice in rural areas (Brigance et al., 2022). Closure of rural hospitals with maternity services and closure of maternity services within rural hospitals that have remained open have increased (Brigance et al., 2022) creating an access to care and travel burden for many. Hospital administrators feel that at least 200 births per year are necessary to make sure maternity and neonatal care providers can maintain their skills and to assure financial viability of a small volume maternity service (Kozhimannil et al., 2022), yet not all birthing hospitals have 200 annual births. There is variation in the ratio of births to maternity service hospital beds based on location and total volume of births, with larger birth volume hospitals able to be more efficient in use of finances and personnel (DeSisto et al., 2022). Smaller birth volume hospitals are often at a disadvantage financially and for recruiting and retaining maternity health care professionals.

It is estimated that 50% of women living in rural areas must travel more than 30 minutes to get to a hospital providing maternity services, compared with only 7% of women in urban areas. Lack of access can lead to adverse outcomes such as preterm births and women giving birth in hospitals without maternity services (Kozhimannil et al., 2018). Virtual care may be an option for patients in maternity care deserts; however, it is not feasible for all because ~20% of U.S. counties have poor broadband coverage (Brigance et al., 2022), which is usually required to participate in a virtual visit. A contributor to access challenges is lack of insurance coverage. The United States must take steps to expand Medicaid coverage in all states and make sure that coverage extends for at least 1 year postpartum for mother and baby (Brigance et al., 2022).

This report should be of interest to all who are involved in maternity care in the United States including clinicians, scientists, policy makers, and advocates.

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