ABSTRACT
Access to maternity care in the United States is becoming more disparate, leading to worsening maternal and infant outcomes in rural communities. Increases in maternal and infant morbidity and mortality are especially prominent in maternity care deserts (MCDs). These MCDs are counties that lack obstetric-specific clinicians such as obstetricians, family physicians, or certified nurse midwives and also lack birth centers or hospitals with obstetric units. This has led to an increase in out-of-hospital births, deliveries in emergency departments, or births at hospitals that are not equipped to manage obstetric and neonatal emergencies. Obstetric unit closures are driven by multiple factors, including reduced clinician staffing, declining birth volumes, and counties with limited income. Potential solutions include changes in policy, growth and diversification of the workforce, and use of telemedicine to improve access to maternity care.