A new study from Birth Injury Lawyers Group finds that the collapse of local maternity care is producing measurable increases in illness, injury, and death for mothers and babies across the United States. A 2025 study cited in the analysis found maternal mortality rates of 32.25 per 100,000 live births in maternity desert counties, compared with 23.62 in full access counties, about 37% higher. Desert counties also recorded higher rates of severe maternal morbidity, including blood transfusions and unplanned hysterectomies. More than 35% of U.S. counties are now classified as maternity care deserts, leaving 5.6 million women with no or severely limited access to obstetric care.
Babies carry the burden too. The national infant mortality rate was 5.52 deaths per 1,000 births in 2024, but in counties with no maternity access it climbed to 6.5 per 1,000. The widest gap appeared in postneonatal deaths, those occurring after the first month but before the first birthday, at 2.6 per 1,000 in desert counties versus 1.8 in full access counties, roughly 44% higher. That pattern suggests the effects reach well beyond delivery day, with reduced access to pediatric follow-up and emergency services playing a role. A separate 2025 study of Medicaid recipients found that women in maternity desert states faced a 34.2% greater risk of maternal mortality, an 18.3% greater risk of infant mortality, and an 8.9% greater risk of low birthweight. Residents of those states were also 14% less likely to receive timely prenatal and postpartum care while living in areas with 30% fewer mental health providers and 36% fewer pediatricians.
One of the most striking findings concerns timing. Federal maternal mortality review data shows that among pregnancy related deaths with known timing, 53% occurred between 7 and 365 days after birth, a window when many mothers are assumed to be recovered and typically receive less intensive care. Cardiomyopathy and untreated mental health conditions, including postpartum depression and substance use, are disproportionately linked to deaths in this period. A single six-week postpartum visit cannot catch risks that emerge or persist for months, which is why the 12-month Medicaid postpartum coverage extension covers the period when much of the preventable risk remains.
Pregnancy complications are also rising. In 2024, 10.4% of mothers (about 377,000 women) developed gestational hypertension, a 73% increase from 6% in 2016. Left untreated, hypertension can progress to preeclampsia, which can trigger stroke, seizure, or preterm delivery, and the CDC notes birth certificates may undercount these cases. Among AIAN mothers, gestational diabetes reached 136.7 per 1,000 births in 2024, up from 113.2 in 2016, a condition that requires frequent glucose monitoring and prenatal visits that are difficult to keep when care is hours away. Postpartum hemorrhage, one of the most time-sensitive obstetric emergencies, demands immediate access to blood products and a surgical team, resources maternity deserts usually lack.
Meanwhile, the infrastructure keeps shrinking. Twenty-one rural labor and delivery units closed in 2024, and another 27 closed in 2025, bringing total losses from 2020 to 2025 to 116. Only 40% of U.S. rural hospitals (950 of 2,396) still deliver babies, just 5.6% have an on-site NICU, and 56.2% sit more than 60 miles from the nearest NICU. All of this is happening as the nation recorded 3,628,934 births in 2024, a general fertility rate of 53.8 per 1,000 women aged 15 to 44, and a record average age at first birth of 27.6, a shift toward later motherhood that often brings added medical complexity.
Targeted solutions are starting to emerge. Louisiana passed legislation in 2025 requiring Medicaid to fund obstetric access so no resident lives more than 30 miles from care. In May 2025, eight states joined a policy academy focused on maternity deserts, exploring Medicaid reimbursement for midwives and doulas, mobile maternity units, and regional care models. In Florida, where 18 of 21 rural hospitals no longer offered obstetric services, a mobile OB/GYN clinic launched in February 2025 and served 194 women across 616 visits by year-end. A $50 billion rural health fund can now support Comprehensive Maternity Care Centers, and Kentucky’s award of about $213 million includes maternal access funding. A federal bill reintroduced in 2026 would further expand care in communities that have lost hospital obstetric services. The study concludes that these efforts are a step forward, but their scale remains far smaller than the problem.