Public Health — News & Analysis

Millions of Americans lack adequate access to prenatal care: Report (August 11, 2026)

WASHINGTON, August 11, 2026 — 5.8 million women now live in U.S. counties without full access to maternity care, according to a new March of Dimes report, and one in three counties remains what the organization calls a maternity care desert. Ashleigh Fields reports for The Hill.

The definition is stringent: a county with no hospital or birth center offering obstetric care, and no practicing obstetric clinicians — no doctors, no midwives. The report, titled "Nowhere to Go," is direct about causation. Maternity care deserts, it says, are "not naturally occurring, nor are they inevitable," but the product of policy decisions and sustained underinvestment in maternity care infrastructure. People in these communities must navigate pregnancy and childbirth with fewer local resources and longer distances to travel. The conditions affect nearly 370,000 births a year.

The geography is stark. 35.9 percent of U.S. counties have no practicing obstetrician clinician at all. Broken out by setting, 57.9 percent of rural counties lack access to one, against 19.4 percent of urban counties — a gap the report attributes to workforce shortages.

Those shortages have identifiable causes. The report cites professional isolation, heavy workloads, and frequent on-call demands, alongside family considerations that make rural practice hard to sustain: limited employment for spouses, housing availability, and long travel distances. It also points to what works. Medical students who complete rural training are more likely to practice in rural settings afterward, particularly those who came from rural backgrounds, which makes rural training pipelines and recruitment central to any long-term fix. Other strategies named include expanding rural training programs, offering loan repayment incentives, and using telehealth to support collaboration and complex case management.

The stakes are framed against the country's international standing. The United States has the highest maternal and infant mortality rates and the lowest overall life expectancy among comparable high-income developed nations.

On remedies, the March of Dimes puts workforce expansion first. Sixteen states have already expanded midwifery practice — independent practice, prescribing authority, admitting privileges, and pay parity for certified nurse-midwives. Separately, 26 states and the District of Columbia now let doulas enroll as Medicaid providers and bill Medicaid directly. The report also calls for opening more birthing centers, ensuring expectant mothers are insured, and improving access to reimbursement programs.

Its final argument is about how care gets paid for. U.S. providers have traditionally been reimbursed fee-for-service, with payment tied to each individual service delivered; value-based payment models instead reward care that is high-quality, coordinated, and cost-efficient. In maternity care that means pay-for-performance arrangements, episode-based bundles, maternity care homes, population-based models, and total-cost-of-care approaches. Scaling those models, the report argues, could improve access, quality, and cost-efficiency at once — and some of them open the door to integrating midwives, doulas, care coordination, and postpartum support into maternity care systems that currently have no structural place for them.