Maternity Care Deserts: An Urgent Public Health Problem in Need of Financial Solutions.

More than 80% of US maternal deaths are preventable yet maternity care in the United States (US) is becoming increasingly difficult to access. Recent years have seen the rise of maternity care deserts, defined as an area with no hospitals or birth centers offering obstetric care and without any obstetric providers. The number of counties without a birthing facility continues to grow, and 1/3 of US counties lack an obstetric clinician. The US has a maternal mortality rate that is 2-3 times greater than similar high-income countries, a steady rise in severe maternal morbidity, and markedly high infant mortality rates compared to similar countries. Traveling long distances to obtain obstetric care can impact whether a woman and infant survive an obstetric emergency such as hemorrhage. Nearly 2/3 of maternity care deserts are in rural areas, with the greatest need for maternity care located in the southern US. Maternity care deserts disproportionately impact rural, low-income, and Black women. The reasons for maternity closures are multifactorial, but are driven by hospital financial pressures and staff shortages. Government interventions are necessary to expand access to care and to keep critical obstetric units open. These interventions include increasing Medicaid reimbursements, expanding Medicaid access, expanding the perinatal workforce, setting standards for what constitutes safe distances between maternity units, and exploring mechanisms to leverage/reimagine existing programs to keep units open in critical areas. We call for urgent action given the serious public health threat to women and infants. We draw from diverse sources not commonly cited to comprehensively summarize the issues related to obstetric closures, outline the drawbacks of many previously proposed solutions, and propose some novel solutions.