Maternity care for pregnant people is becoming increasingly scarce across the country, with 36% of U.S. counties being classified as maternity deserts, according to the National Library of Medicine.
According to a March of Dimes report from 2024, Ohio has not been spared from this issue. 18.2% of counties across the state are considered maternity care deserts, and an additional 18.2% of counties have low or moderate access to maternity care.
The National Library of Medicine classifies a maternity desert as a county that has no hospital or birth center offering obstetric care and has no obstetric clinician.
Southeast Ohio houses 7 of the 13 counties classified as maternity deserts in Ohio.
Ohio University’s Department of Social and Public Health associate professor Cory Cronin said these rural communities do not provide enough consistent need for maternity services to sustain those operations.
“Many rural communities do not have the volume to support any one particular specialty service that could give them an entire patient load or sustainable business,” Cronin said.
John Palmer, Director of Dedia and Public Relations for the Ohio Hospital Association, noted a major decrease in births across Ohio in recent years as one reason for maternity ward closures. According to Palmer, the number of births across the state decreased from 129,313 in 2020 to 121,000 in 2024.
The lack of utilization of these maternity services often provides income-based issues for hospitals. Palmer went on to cite cost as a prevalent issue with maintaining maternity care in rural areas.
According to Cronin, the fixed cost for maintaining maternity operations is too high to support the low volume that rural communities provide, citing that suburban and urban communities have a higher volume of patients.
Cronin commented on why hospitals are closing down these services after experiencing low volume.
“I do think it's financial pressures for rural hospitals,” Cronin said. “I think they are facing negative operating margins, and some of them do see this as a way to slow the loss of money for their organization at the end of the year.”
Since 2020, 21 hospitals across Ohio have either closed their maternity services or consolidated those services to a neighboring hospital with maternity services.
Cronin said even though rural communities do not have the volume of maternity patients to support entire maternity wards, the need for care in rural areas is still present. The gap in obstetric care for pregnant people in rural communities is only growing, and to combat this, many are advocating for more support from urban areas.
“There's been some efforts to not only get facilities but mobile clinics and satellite locations to do telehealth as well,” Palmer said. “But it's more of a hub and spoke, where it's investment happening to build out, like in Athens.”
Palmer mentioned Ohio Health’s Wellness on Wheels. This initiative has multiple buses that travel through both Central and Southeast Ohio, delivering primary care, as well as women’s health services and prenatal care.
Additionally, Ohio has moved toward allowing health officials to address prenatal care via telehealth, according to the Managed Care Plan by the Ohio Department of Medicaid. These telehealth services can provide care for rural communities without requiring transportation.
An issue with the expansion of telehealth resources for maternity deserts is that rural communities in Ohio often experience weaker internet connections than urban areas. According to an OU study, Southeast Ohio is significantly behind in broadband coverage.
Cronin said it is vital to track and monitor a pregnancy through its entire term, ensuring the pregnancy is healthy. He argued that access points in rural communities are vital to check on pregnancies long before labor and delivery, as a healthier pregnancy typically leads to a healthier delivery.
“The solution might not always be that the services are right in your own backyard, but are we preparing ourselves to have the right information and networks that people can get connected to the services in the most convenient way, or logical way, that they can get them,” Cronin said.
