The Lotus Assembly

Millions of Moms
Have Nowhere to Go

Over a third of U.S. counties have zero hospitals, birth centers, or OB doctors. This is what a maternity care desert is, and it's getting worse. Here's what you need to know, and what we can do.

35% of U.S. counties are
maternity care deserts
2.3M women of reproductive
age live in deserts
100+ hospital OB units
closed since 2022
What Is a Maternity Care Desert?
In plain terms

Imagine being pregnant and having no hospital, no birth center, and no OB doctor anywhere in your county. That's a maternity care desert. It means when it's time to give birth, or when something goes wrong during your pregnancy, there is no place nearby to go. Women in these areas must drive long distances, sometimes over an hour, just to get basic pregnancy check-ups. In an emergency, that drive can cost a mom or baby their life. Over 1,100 counties across America are in this situation right now. And the number keeps growing.

The 4 Levels of Maternity Access
How the March of Dimes classifies every county in the U.S.

🚫 Maternity Care Desert

Zero birthing facilities AND zero obstetric clinicians. 35.1% of all U.S. counties.

⚠️ Low Access

One or fewer hospitals, very few OB providers, or high rates of uninsured women.

🟡 Moderate Access

Some services available but not enough to fully meet community need.

✅ Full Access

Adequate facilities, obstetric providers, and insurance coverage. Far too rare.

Source: March of Dimes, "Nowhere to Go: Maternity Care Deserts Across the US," 2024 Report.

What the Data Says About Risk
Living in a desert isn't just inconvenient. It's dangerous
13%

higher risk of preterm birth for women in maternity care deserts

38 min

average drive to nearest birthing hospital from a desert county

5.5M

women live in counties with no or very limited maternity care access

Source: March of Dimes 2024 Report; PMC geographic access study.

States with the Most Maternity Care Deserts
Ranked by percentage of counties classified as deserts (March of Dimes 2024)
Over 50% of counties are deserts
Elevated: 35 to 50%
North Dakota 73.6% of counties Highest in the nation. Vast rural distances with no OB care
South Dakota 57.6% of counties Native American communities face the most severe access gaps
Oklahoma 51.9% of counties Rural hospital closures have dramatically reduced OB options
Missouri 51.6% of counties More than half of counties have no birthing facility or OB doctor
Nebraska 51.3% of counties High desert rates despite a relatively small total population
Arkansas 50.7% of counties Half of counties are deserts; high poverty compounds the risk
Alaska Among the longest average drive times to reach a birthing hospital
Montana Highest travel distances nationally; Indigenous women especially impacted

Source: March of Dimes 2024 MCD Report; PMC geographic access study.

Who Is Most Affected?
These groups face the highest barriers inside maternity care deserts
🌾

Rural women

Maternity care deserts are far more common in rural counties. Women without a car or reliable transportation are the most vulnerable of all.

🪶

American Indian & Alaska Native women

Native women travel an average of 45.9 minutes to reach the nearest OB hospital, more than 3× the national average. In desert counties, that can jump to over 2.5 hours.

💳

Uninsured & low-income women

The rate of uninsured women in maternity care deserts is 2× higher than in areas with full access. No insurance means fewer options and more dangerous delays.

🤰

Women with high-risk pregnancies

Women with diabetes, hypertension, or past pregnancy complications need closer monitoring. In deserts, they often go without care until it becomes an emergency.

What WE Can Do
Practical steps every woman can take right now
1

Know your county's access level

Look up your county on the March of Dimes interactive map at marchofdimes.org/maternity-care-deserts-report. Share your results with other women in your community.

2

Demand telehealth & mobile health expansion

Telehealth prenatal visits are proven to work for routine care. Contact your state legislators and ask them to fund mobile maternal health clinics in underserved areas.

3

Push for rural hospital protections

Over 100 hospital OB units closed between 2022 and 2024. Ask your congressional rep to support the Rural Maternity and Obstetrics Management Strategies (RMOMS) program.

4

Support midwife & doula access laws

Expanding the legal scope of midwives and funding community birth centers can fill gaps where hospitals don't exist. Many states still have laws blocking this. Speak up.

5

Volunteer transportation or logistics help

Women in deserts sometimes travel 1 to 3 hours for prenatal appointments. Offer rides, childcare during appointments, or donate to local funds that cover travel costs.

How to Band Women Together
Turn awareness into a community movement

Start a "Desert Watch" network in your area:

🗺️

Map your community's access gaps

Use the March of Dimes county map to print your area's access level. Host a community meeting to show local women the data and spark real conversation about solutions.

🚗

Start a rides & logistics circle

Organize a network of drivers who volunteer to take pregnant women to prenatal appointments. Pair with a simple group chat and shared calendar. No fancy tech needed.

📲

Create a county-level care resource list

Research every telehealth OB service, federally-qualified health center (FQHC), and mobile clinic available in your county. Update it quarterly and share it everywhere.

✍️

Host a letter-writing or phone-banking day

Gather women and spend one hour contacting your state health department and elected officials. Ask them to protect rural hospital OB units and fund community birth centers.

Join The Lotus Assembly

Fill in your info below and I will personally reach out by email to connect you with women in your area, share free resources about maternity care access near you, and let you know how to get involved. You will not be left on a list. You will hear from me.

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