35% of U.S. Counties Are Maternity Deserts—Midwives Step In as Hospital OB Units Close

For healthcare administrators and clinicians, the expansion of maternity deserts poses a critical threat to population health. With over half of U.S. counties lacking hospital-based labor and delivery, care models are shifting toward midwifery—yet reimbursement and regulatory barriers persist. This story from Alabama illustrates both the promise and the policy gaps in maternal care delivery today.

A major new report from the March of Dimes reveals a stark and worsening landscape for maternal care in the United States. According to the 2026 "Nowhere to Go" report, over 52% of U.S. counties have no hospital-based labor and delivery services, and 35% are classified as maternity care deserts—areas with no birthing facilities or obstetric clinicians at all. This represents a deepening crisis, as millions of women must travel long distances for prenatal care and delivery, directly contributing to adverse outcomes. The report underscores that more than 20,000 babies die before their first birthday each year, and roughly 600 women die annually from pregnancy-related complications, with rates significantly higher among Black and Indigenous populations.

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According to the 2026 "Nowhere to Go" report, over 52% of U.S.

Against this backdrop, the story of Nadia Gramby, a midwife who crisscrosses Alabama to serve pregnant women, offers a human-scale illustration of how gaps are being filled. Alabama is heavily affected by maternity deserts, with large swaths of rural counties having lost obstetric services due to hospital closures and physician shortages. Gramby not only provides prenatal care and deliveries but also represents a model of community-based care that is increasingly essential. Her work highlights the vital role midwives play, particularly for Black mothers who face systemic barriers and elevated risks. The March of Dimes data show that access to care is not just about geography; it is deeply intertwined with racial health inequities, as Black women are three times more likely to die from pregnancy-related causes than white women.

Dr. Michael Warren, chief medical and health officer for the March of Dimes, describes the situation as "beyond a mere inconvenience," noting the direct link between living in a desert and bad pregnancy outcomes. The report’s findings arrive as the U.S. continues to grapple with a maternal mortality rate that far exceeds other high-income nations, a problem that has drawn attention from policymakers, healthcare systems, and advocates. The expansion of maternity deserts threatens to reverse any progress made in recent years, unless systemic changes are implemented.

The implications for the healthcare industry are profound. First, the growing reliance on midwives and nurse practitioners to fill physician gaps raises questions about scope-of-practice laws, reimbursement models, and integration with hospital systems. Many states restrict midwifery through licensure and collaborative agreement requirements, limiting their ability to practice independently—a barrier that directly affects women in deserts. Second, the data serve as a call for investment in telehealth and remote monitoring, which could allow providers like Gramby to extend their reach. Third, the crisis may accelerate payer innovation, with Medicaid and private insurers exploring direct reimbursement for community-based midwifery and doula services, which studies show improve outcomes and reduce costs.