The report examines maternity care access using 2 measures that quantify the need for maternity care services in each county. The first is March of Dimes maternity care access designations. The second is new to the 2024 report: a continuous measure based on a index score created in 2022 by the Health and Resources Service Administration (HRSA) to classify counties with need for maternity care, based on the following 6 factors:
According to the data, more than 2.3 million reproductive aged women live in maternity care deserts. That's an increase of .1 million compared to data from the 2022 report. One hundred and fifty thousand babies were born to women living in maternity care deserts, an increase of 4,000 since 2022.
Yet while more women are giving birth in maternity care deserts, the report shows that the overall percentage of counties qualifying as deserts has gone down, from 36% to 35%.
Additionally, options have improved for those living in areas with limited access. In 2022, 4.7 million women lived in areas with limited maternity care access, and 300,000 babies were born. According to 2024 data, those numbers have significantly decreased: three million women live in counties with limited maternity care access and 200,000 babies were born to women living in these areas. This is not just a shift in demographics -- counties that were formerly classified as low access have shifted to higher access of care.
This report affirms the story that medical data has been telling for some time -- Americans are sicker than they used to be. Women in minority communities and women living in maternity care deserts are disproportionate victims of rising rates of chronic conditions related to maternal health, like pre-pregnancy obesity, hypertension, and diabetes.
Yet while the increase in chronic conditions is shared across the general population, a decrease in fertility rates observed is not seen populations with low access: fertility rates in rural counties and maternity care deserts are higher than urban and full access counties and are decreasing at a slower pace.
The report reveals two important things -- advocacy works, and advocates cannot let up.
In their 2022 report, the March of Dimes (MOD) called for expanding Medicaid and extending Medicaid postpartum coverage to 12 months. Now, in 2024, all states with one exception have implemented or approved the implementation of the expansion. MOD also called for coverage of evidence-based telehealth maternal health services and alignment of telehealth reimbursement approaches across payers. While this is far from being realized, federal and state governments have made positive steps in that direction, including the CMS rollout of the Transforming Maternal Health (TMaH) Model, an investment in state Medicaid agencies designed to focus exclusively on maternity populations and including provisions for remote patient monitoring solutions.
The report ends with a series of recommendations for building on current progress, including the following:
These recommendations provide a blueprint for policymakers to support quality maternal healthcare that is accessible and equitable, and offer an approach to improve health outcomes and foster an infrastructure that serves the needs of all mothers and babies.