March of Dimes: Over One-Third of U.S. Counties Remain Maternity Care Deserts

The March of Dimes biennial report titled "Nowhere to Go: Maternity Care Deserts Across the U.S." presents an urgent public health reality. Approximately 34.6 percent of all counties across the United States remain designated as maternity care deserts. These regions have zero hospitals offering obstetric services, zero accredited birth centers, and zero practicing obstetric clinicians (OB/GYNs or Certified Nurse-Midwives). This care deficit directly affects more than 2.4 million women of reproductive age.

Nationwide, hospital financial pressures, staffing shortages, and liability costs have driven at least 96 labor and delivery unit closures since January 2024. These shutdowns force pregnant families into extended travel times. Patients in maternity care deserts travel an average of 34 miles for hospital birth, compared to just 9.7 miles for individuals living in counties with full obstetric access.

Longer travel times to hospital obstetric units are associated with a 22 percent increase in the risk of severe maternal morbidity and an 18 percent higher rate of admission to neonatal intensive care units (NICUs). This geographic barrier directly correlates with missed prenatal appointments, unmanaged gestational conditions, and higher rates of emergency out-of-hospital deliveries.

In Arizona, the distribution of obstetric care mirrors national disparities. While urban centers in Maricopa County boast world-class perinatal facilities, adjacent rural and suburban communities experience significant provider shortages. Over the past several years, regional hospital system shifts, including rural unit closures in Pinal County and across northern Arizona, have concentrated deliveries into high-volume metropolitan hubs.

Patients living in Casa Grande, Maricopa, Apache Junction, and outlying desert areas face 45-to-75-minute commutes on congested interstate corridors to reach staffed labor and delivery floors at Banner Desert Medical Center, Chandler Regional, or Mercy Gilbert. For multigravida patients with rapid labor histories or individuals with preeclampsia, prolonged travel creates acute clinical vulnerability.

National maternal health policy organizations, including the American College of Obstetricians and Gynecologists (ACOG) and the American College of Nurse-Midwives (ACNM), identify Certified Nurse-Midwives as central to eliminating maternity care deserts. In Arizona, CNMs hold autonomous Advanced Practice Registered Nurse (APRN) licensure under the Arizona Board of Nursing, with independent diagnostic and Schedule II-V prescriptive authority.

Deploying hospital-based and outpatient CNM practices into peripheral health centers preserves local prenatal access. Midwives handle uncomplicated antepartum care, routine screenings, and low-intervention physiologic births, while hospital collaborative agreements ensure seamless physician backup for surgical or high-acuity interventions. This division of labor allows physician specialists to focus on high-risk surgical cases while expanding community access for low- and moderate-risk pregnancies.

Midwifery-led community prenatal clinics allow patients to complete 90 percent of their appointments locally, traveling to regional hospitals only for delivery. States with high midwifery integration demonstrate significantly lower rates of primary cesarean births, lower preterm delivery rates, and improved patient satisfaction.

Closing the desert gap requires combining local clinical staffing with remote digital health. Forward-thinking healthcare systems utilize hybrid prenatal schedules. Routine blood pressure monitoring, fetal Doppler checks, and physical exams occur in neighborhood clinics staffed by CNMs and nurse practitioners. High-risk consultations for preexisting diabetes or multiple gestations occur via secure telehealth with maternal-fetal medicine physicians.

This integrated approach protects patient autonomy and reduces financial strain. Patients no longer take half-day leaves of absence or arrange complex transportation across county lines for basic prenatal checks. When labor begins, patients arrive at well-equipped regional hospitals where their midwifery care plan is already established.