Photo: Bryan Goodchild
The United States continues to face a growing maternal health crisis. Despite being one of the most resource-rich nations in the world, America has the highest maternal mortality rate among wealthy countries and it’s worsening. A 2025 report found that nearly half of U.S. counties lack a single obstetrician, midwife or birthing facility, creating what experts call “maternity care deserts.”
Tiffany A. Moore Simas, MD, MPH, MEd, MHCM, the Donna M. and Robert J. Manning Chair in Obstetrics and Gynecology, chair and professor of obstetrics & gynecology, and professor of pediatrics, psychiatry & behavioral sciences and population & quantitative health sciences at UMass Chan Medical School, explains what’s behind this trend and how it can be reversed.
Why is maternal mortality in the U.S. so high and why should people care right now?
“It’s a significant, complicated problem,” Dr. Moore Simas said. “Despite being a resource-privileged country, we’ve undervalued the care of women and children for decades, if not centuries, and those that provide that care.”
She said maternity care in the U.S. has been chronically underfunded. “We haven’t invested enough in women’s health infrastructure and we’ve seen the results—closures of maternity and birthing centers, workforce shortages, and limited access to care. Adding current risks to Medicaid funding and reproductive rights, we could see maternal mortality rates go up, especially in states limiting reproductive choice.”
What does it mean when we talk about ‘maternity care deserts’?
“Almost 50 percent of U.S. counties are now considered maternity care deserts,” she said. “That means they don’t have an obstetric provider or a birthing facility at all.”
That leaves more than 6.9 million patients and nearly 500,000 births each year in areas with little to no access to maternity care—forcing many to travel hours for appointments or deliveries, putting both mothers and babies at higher risk.
Why are so many hospital maternity units closing, even in states like Massachusetts?
“It’s multifactorial,” said Moore Simas. “Workforce shortages are a huge piece of it. There are simply not enough OB/GYNs, midwives, and labor and delivery nurses to safely staff these units, and it’s harder to recruit into rural communities.”
Financial pressures are another factor. “It’s expensive to run a maternity unit due to high overhead costs—it must be open 24/7 and payers don’t reimburse in a way that makes it financially viable, especially for smaller community hospitals.”
“Fortunately for patients in Central Massachusetts, there are still adequate options for maternity care,” Moore Simas added. According to March of Dimes, Massachusetts has no maternity care deserts, and 91 percent of all zip codes are within a 30-minute drive of a maternity hospital.
Why don’t we have enough OB/GYN doctors and midwives?
“The country is not training enough,” she said. “There’s a mismatch between how many OB/GYNs we need and how many training slots exist. One in five U.S. medical students who want to go into OB/GYN won’t match because there aren’t enough positions.”
This isn’t due to lack of interest, she emphasized, but lack of investment. “The care of women and children has not been highly valued in the broader health care ecosystem. It’s been underfunded and undervalued, both in reimbursement and in policy priorities.”
How are these shortages affecting patients?
“When staffing is limited, we have to make difficult choices,” Moore Simas said. “Earlier this year, we had to prioritize pregnant patients over gynecologic patients because of vacancies. We were rescheduling annual exams and referring some patients elsewhere. Fortunately, we recruited highly accomplished providers and are now open to all. That is not true everywhere though.”
This reflects a national trend, as hospitals and clinics struggle to balance limited staff with the urgent need for maternity care.
What drives the higher risks for Black women and people in rural communities?
“There’s no single answer. It’s deeply systemic,” said Moore Simas. “Racism, bias and structural inequities play enormous roles.”
She pointed to “implicit bias” in medical care—who gets heard and believed—as well as lifelong stress from experiencing racism, which research links to higher risks of preterm birth and low birth weight. “Underinvestment in hospitals, schools and communities ties directly back to social determinants of health and poor outcomes for those regions,” she added.
What would it take to fix this crisis?
“We have people who want to go into OB/GYN. We just need enough training positions,” said Moore Simas. “It’s also about creating more sustainable care models. That means supporting midwives, family medicine physicians trained in obstetrics and team-based approaches where everyone’s contributions are valued and everyone is practicing to the top of their license. It also means providing appropriate reimbursement tied to better outcomes.”
Training should also reflect the realities of different practice settings, she said. “Most residents train in large, urban hospitals with lots of support. But the real need is in smaller community and rural hospitals where they may be the only provider across multiple counties. We need to train people for that reality.”
Looking ahead
Moore Simas said addressing the OB/GYN shortage will take coordinated national and state action: expanding training programs, improving reimbursement models and recognizing maternity care as a public health priority.
“Without urgent investment, maternity deserts will keep growing,” she said. “But with the right policies and a commitment to valuing women’s health, we can turn this around and make sure every family has access to safe, high-quality care.”
