By NextBestFitMaternity care deserts
Over a third of U.S. counties have no maternity care. Obstetric units close because births are low-volume and Medicaid (which pays for about 41% of births) pays little.
Evidence
- Over 35% of counties are maternity care deserts; 5.5M+ women in counties with no or limited care; more than 100 hospitals closed obstetric units in 2021–22.Sources: March of Dimes (2024)
Who's affected
Who is hurt
- Pregnant and postpartum people and infants: Obstetric unit closures leave pregnant people and newborns without local maternity care.
- Rural residents: Obstetric unit closures leave pregnant people and newborns without local maternity care.
Who gains while it lasts
None identified.
Under your mix of paths
Paths that create or worsen it
Paths that fix or soften it
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Root causes
- Low payment for births
- Staffing and liability costs
- Low volume
Related costs
Open questions
- Should obstetric units be funded as essential infrastructure?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Convert to emergency and outpatient centersRural hospital closuresChosen
Dropping inpatient beds means patients must travel farther for births, with transfer agreements connecting the emergency center to hospital care.
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Pay rural labor and delivery units a fixed amount for readiness, not per birth.
- +Maternity care deserts
- +Getting to care: transportation and ambulances
- +Medical errors and poor care coordination
- −Medical errors and poor care coordination
- −Raises spending or loosens control over it
License and pay certified midwives and freestanding birth centers, with transfer agreements.
- +Maternity care deserts
- −Adds paperwork, coordination, or complexity
- −Quality concerns when non-physicians practice independently