Left Behind to Give Birth: How Medicaid Cuts and Hospital Closures Are Creating Maternal Health Deserts Across Our Country

September 8, 2025

In the military, one of the most sacred principles is this: no one gets left behind. On the battlefield, it doesn’t matter how dire the conditions are—soldiers risk everything to retrieve their wounded, to carry their comrades to safety, to honor the unspoken promise that every life matters.

But in our healthcare system, especially in rural and underserved communities, pregnant people are being left behind every day.

In the wealthiest nation on earth, it should be unthinkable that millions of women live in counties with no access to obstetric care. Yet today, more than one-third of U.S. counties are classified as maternal health deserts—places where hospitals lack obstetric services, birth centers are nonexistent, and there are no practicing OB/GYNs or certified nurse midwives. These deserts disproportionately affect Black, Indigenous, and rural communities, deepening the racial and geographic inequities that already plague our healthcare system. It's as if we've abandoned our own comrades on the battlefield of childbirth.

What Is a Maternal Health Desert?

A maternal health desert is a region where pregnant people cannot access essential maternity care. This includes:

• No hospitals offering labor and delivery services

• No birth centers

• No OB/GYNs, midwives, or family physicians providing prenatal or postpartum care

The consequences are devastating:

• Higher rates of maternal and infant mortality, 80% of which are considered preventable

• Increased risk of complications due to delayed or absent care

• Long travel times for basic prenatal visits or emergency deliveries

The current maternal landscape already shows that Black and Indigenous women are nearly three to four times more likely to die from pregnancy-related causes than white women, and rural women are 60% more likely to die than their urban counterparts. These disparities are not accidental—they are the result of policy choices and systemic neglect.

The impact is especially severe in rural and mountainous regions, where travel times to care can stretch over an hour. For high-risk pregnancies, that delay can be deadly.

Why Are Hospitals Closing?

The March of Dimes 2024 Report  on maternal health deserts shows hospital closures have accelerated across the country, especially in rural and underserved areas. Labor and delivery units are often the first to go, deemed “non-essential” by administrators trying to cut costs. The data shows that in 1,104 US counties, there is not a single birthing facility or obstetric physician, midwife or family doctor trained to deliver a baby. These counties are home to over 2.3 million women of reproductive age and 150,000 babies born in 2022, making these closures catastrophic for the communities they serve. The reasons are complex but interconnected:

• Financial strain: Many hospitals that serve Medicaid or uninsured populations operate on razor-thin margins

• Low patient volume: Rural hospitals often serve fewer patients, making it harder to stay solvent

• Rising costs: Labor, equipment, and technology expenses continue to climb

• Policy shifts: Changes in Medicare and Medicaid reimbursement rates can make or break a hospital’s budget

• Workforce shortages: Recruiting and retaining OB/GYNs and midwives in rural areas is increasingly difficult, especially in states with restrictive reproductive health laws

Medicaid Cuts: A Ticking Time Bomb

Medicaid is the lifeline for millions of low-income families and the backbone of rural hospital funding. Medicaid covers approximately 40% of births in the United States. Yet proposed federal cuts to Medicaid threaten to push hundreds more hospitals into financial ruin.

In my home state of North Carolina—where Medicaid expansion arrived only recently—proposed 2026 cuts threaten to hit rural counties hardest, worsening existing challenges in retaining maternity care and accelerating a statewide maternal health crisis.

A recent analysis found that:

• 55 additional rural hospitals could face negative net income in 2026 due to Medicaid cuts

• These hospitals could lose an average of 56% of their yearly net income

• Over 300 rural hospitals are already at immediate risk of shutting down

We would never accept a military operation that left its wounded behind. So why are we tolerating a healthcare system that leaves mothers to labor alone—miles from care, with no backup, no support, and no plan?

Maternal Health Is a Frontline Issue

Maternal health is not a luxury—it’s a frontline issue. Every hospital closure, every Medicaid cut, every policy that sidelines maternal care is a choice. And those choices are costing lives.

This urgency calls us to:

• Vote for policymakers who support fully funding Medicaid, including rural hospitals, with sustainability in mind

• Invest in midwifery and community-based care models that meet families where they are

• Protect reproductive rights to retain skilled providers and ensure safe, dignified care

• Support telemedicine infrastructure to bridge care gaps in maternal health deserts, ensuring no mother is left without access—regardless of where she lives

• Encourage hospital designations to include distinct levels of maternal care, clearly defining their capacity to manage low-, moderate-, and high-risk pregnancies—so families and providers can make informed decisions and systems can be held accountable

• Advocate for dedicated state funding for Maternal Mortality Review Committees (MMRCs) through the Preventing Maternal Deaths Reauthorization Act and related oversight bodies that track and analyze serious maternal illnesses and deaths

• Find out if you live in a maternity care desert—and take action

Just as we would never abandon a soldier on the battlefield, we must refuse to abandon pregnant women. Maternal health deserts are not inevitable. They are reversible—if we act with the urgency this moment needs and have policies that reflect an unwavering commitment to protect and serve. And, as evidenced by the recent archiving of the CDC’s pregnancy-related death dataset, the only help coming is what we, as taxpayers and advocates, are prepared to demand.

Resources: ACOG's Policy Priorities for Maternal Health and National Academy for State Health Policy