Editor’s Note: This story is one in a series The Post is publishing as a part of the Solutions Journalism Network’s Student Media Challenge. Stay tuned for more stories about maternity deserts and other solutions in the coming months.
What are maternity deserts?
In 2022, over 2.3 million women lacked access to quality maternity care and more than 150,000 babies were born in places without proper care, meaning their county did not include a hospital offering obstetric services or birth centers and no obstetricians, gynecologists or certified nurse midwives. Athens County, a low access area itself, is surrounded by counties with extremely limited access to maternal care.
In the U.S., this is known as a maternity desert, which affects 35% of counties across the nation. According to a 2024 report, 16 out of 88 Ohio counties are considered maternity deserts, including Vinton, Hocking and Perry counties.
Seven of these 16 counties are in Southeast Ohio, making it the region with the highest concentration of maternity deserts in the state. Cory Cronin, an associate professor in the Department of Social and Public Health, said the Appalachian region as a whole faces maternity deserts and will need additional resources to address the issue.
“Across the state, when one region is facing the impact of a trend like this so significantly, you do need to look to things like policy and collaborative networks,” Cronin said. “Organizations aren't going to be able to move the needle on their own. They're going to need resources, workforce and partners to address this challenge.”
Counties can also be classified as having low access to maternity care, moderate access or full access. Around 3.3 million women live in counties with limited access, according to updated data from March of Dimes. Low access care means the county has one or fewer hospitals or birth centers in which obstetric care is provided, fewer than 60 obstetric clinicians per 10,000 births or greater than or equal to 10% of reproductive-aged women without health insurance.
“Many people know somebody (or) are somebody who have trouble receiving the services they need in that time, and it has to do with women and children, a significant population when we look at health policy priorities,” Cronin said.
Maternal care is essential to the survival of mother and baby. Over 80% of pregnancy-related deaths in the U.S. are considered preventable, many of which could be avoided with quality care, according to the U.S. Centers for Disease Control and Prevention.
"(The problem is) one in which a population is very defined, and the needs of that population are relatable and understandable," Cronin said. "When we look at Ohio, there's significant room for improvement in maternal health outcomes and care.”
Local & campus outreach
Ohio University’s Heritage College of Osteopathic Medicine houses the Obstetrics and Gynecology Club. President of OB/GYN Club, Gabriella White, a medical student at Heritage College, said the club organizes events for students interested in obstetrics and gynecology.
According to the club’s website, its mission is to “provide comprehensive information on training and career opportunities, facilitate discussions on women’s health issues and foster an environment where students can connect with experienced professionals in the field.”
OB/GYN Club holds fundraisers for a variety of diseases, including breast cancer, provides training events for students to increase performances and attends panels of OB physicians who attend meetings.
“But really, it’s what the students want to see,” White said. “If they wanted to see somebody come in and talk about fertility, then we could find a speaker to come talk about fertility specialties and things like that.”
White discussed her involvement in the Rural and Urban Scholars Pathways Program, a learning community that aims to support and prepare medical students to practice in medically underserved areas. White said through the program, she was introduced to the concept of maternity deserts.
White said smaller hospitals in Ohio and other states lack sufficient funding for OB programs, and as a result, they often shut down.
The OB/GYN Club has played a role in bridging gaps within the region's maternity health care. White said as OU recruits medical students from rural Ohio, it’s beneficial to rural areas within the state that lack access.
“By recruiting those students to be in your program, you would think they want to go back home and serve that patient population,” White said. “I think that’s something OU’s doing.”
Ohio announced the Comprehensive Maternal Care program in 2022 to improve health outcomes for pregnant and postpartum Medicaid patients at the community and statewide level. Clinics that use this program ensure patients are linked to resources that address broader factors of health, like housing and food instability.
Clinics providing CMC in Southeast Ohio include Adena Medical Group in Chillicothe in Ross County, Muskingum Valley Health Centers in Malta in Morgan County, Marietta Memorial Hospital in Marietta in Washington County and Holzer Clinic in Gallipolis in Gallia County, according to a CMC 2025 enrolled practice list.
Regional outreach
Midwives are bridging the gap in counties experiencing maternity deserts. Because they can travel to expectant mothers, midwives help reduce the long drive times that many pregnant people face and increase access to prenatal care in rural areas. According to March of Dimes, 6.5% of women living in Ohio had no birthing hospital within 30 minutes compared to 9.7% in the U.S.
Through storytelling and shared experiences, midwives strive to transform the birthing process and create everlasting connections with mothers across counties in Southeast Ohio.
A midwife is a trained “health care professional who cares for people during pregnancy and childbirth,” the Cleveland Clinic states. Types of midwives include certified nurse midwives, certified midwives, certified professional midwives and unlicensed or lay midwives. Most often, midwives travel to their patients, expanding the potential for care in counties without a birth center.
According to Midwife Schooling, CNMs attended more than 12% of births in Ohio in 2023, an increase from 7% a decade ago. Midwife-led care “is associated with lower C‑section rates (~5% in midwife-attended cases vs. ~30% statewide in Ohio), lower preterm and low birth weight, and greater breastfeeding initiation,” according to the Buckeye Birth Coalition.
There are also direct-entry midwives, who enter the midwife practice directly, without “nursing education and licensure,” the American Association of Managed Care Nurses states.
As of 2021, CNMs are the only “legally enabled professional midwife type who can practice in Ohio,” according to The Center for Community Solutions. Per Ohio Revised Code section 4723.41, CNMs must meet requirements including “licensure as an advanced practice nurse.”
For an aspiring CNM to receive their license, Midwife Schooling states they must earn a qualifying degree in nurse midwifery, take and pass the national certification examinations, apply for an advanced practice registered nurse certificate of authority as a nurse-midwife through the Ohio board of nursing, explore career opportunities as a nurse midwife in Ohio and maintaining credentials and review CNM salary and job outlook in Ohio.
Erica Andrews, a midwife at Laughing Moon Midwifery in Athens, calls herself a “community” midwife because the state of Ohio does not offer a CM or CPM title. Unlike direct-entry midwives, Andrews does have schooling and training in midwifery.
Andrews aspires to combat the growing issues surrounding access to prenatal care. She is on call 24/7 and supports three to four expecting mothers every month. Andrews said she and expecting mothers often develop a trustworthy relationship.
“We spend so much time together,” Andrews said. “ … We do a lot of storytelling in our prenatals, it's how we pass knowledge … I find that in prenatal care, when we spend so much time together and we're telling them stories about the things that they're asking, that is where trust comes from.”
Despite the benefits a midwife can offer for expecting mothers, Andrews is just one of the few practicing midwives in Southeast Ohio. In Ohio, 97% of counties do not have midwives and 30% do not have advanced practice midwives, according to a November 2025 study by the University of Washington.
For expecting mother Paige Fox, who is due in June, receiving care from OhioHealth O’Bleness Hospital in Athens is the most practical option. Fox lives in Meigs County, which is classified as “low access to care” according to the March of Dimes report, and lives about a 30-minute drive from O’Bleness. Fox said she researched nearby midwives to avoid the long drive, but was unsuccessful.
“I did look into multiple midwives, and it was frustrating that there just weren’t more options,” Fox said. “Some didn’t work out for various reasons, like my due date didn’t work for them, they were on vacation or too far away.”
Fox said she is seeing an obstetrician and is satisfied with the care; however, she still has concerns.
“If anything were to go wrong, we are far away,” Fox said. “It's not a knock on O'Bleness, but it kind of feels like you're settling.”
Fox said she travels to O’Bleness every four weeks for check-ups, but will have appointments every two weeks in her third trimester.
According to Adoptions with Love, the average cost of childbirth and postpartum care is nearly $19,000 for an expectant mother. The average cost of childbirth at an Ohio hospital costs $15,149 without insurance coverage. Those with insurance coverage pay around $3,000 out-of-pocket, depending on the type of delivery.
These prices can be daunting for some Ohioans, as 21% struggled to pay off their medical bills in 2023, according to the Ohio Medicaid Assessment Survey.
Andrews’ care costs $4,500 per client and includes all prenatal care, lab draws, birth support and postpartum care.
It was not Andrews’ plan to become a midwife. The OU alumna studied anthropology, but after an epidural scare during her second pregnancy, she became curious about different birth processes. Andrews had her third baby with a midwife and said the experience altered her perspective; she said it felt “powerful.”
“I felt like I just climbed to the top of a mountain, and I came down with a baby,” Andrews said. “Nobody did anything for me except held space for me … and that was one of the most empowering moments of my life.”
Andrews said the “safest” type of birth is physiologic birth, a type of natural birth concerning expecting mothers undergoing a “low risk” pregnancy and in good health.
A physiologic birth or “normal childbirth,” as stated by the World Health Organization, takes place between 37-42 weeks of pregnancy and “starts spontaneously,” excluding induced labor and pain medications.
“(Physiologic birth) is the safest for the baby,” Andrews said. “It is the number one thing we could do as a society to lower our maternal and infant mortality rates.”
The National Library of Medicine states normal physiologic labor and birth can have short and long-term benefits for mothers and newborns, including physical and emotional strength, enhanced infant growth and development and a potential decrease in chronic disease.
“I wait for a baby to show me it needs help, because if a baby needs help, you're going to know,” Andrews said. “Very rarely do babies need you to help them be born and they have their own innate awareness thanks to newborn reflexes.”
Fox said her goal is to avoid “unnecessary interventions” during the birth; however, it is hard to determine the proper time to go to the hospital.
“If you are too soon, sometimes (doctors) want to intervene,” Fox said. “They’re like, ‘Let’s get this going.’”
Fox said the birth of her first daughter was unmedicated, but she did face pressure from the nurses to take pain medications.
“It was the only negative experience that I’ve had,” Fox said. “When I was getting checked in to have her, I expressed I did not want an epidural. The admitting doctor tried to use it almost like a scare tactic … and I still denied it. I had comments from nurses about it taking longer because of that, and just kind of comments in front of me that weren't positive.”
Each expecting mother across Southeast Ohio can hold a different viewpoint on where and how they want to give birth. Although long drives to the hospital and other challenges stand in the way, midwives and doctors across Ohio’s 17 hospitals and independent practices aspire to help expecting mothers in need.
State outreach
In Dec. 2025, Gov. Mike DeWine announced Ohio will receive over $200 million through the Rural Health Transformation Program, an initiative authorized by President Donald Trump’s One Big Beautiful Bill Act. The application for the funding was submitted by the Ohio Department of Health with assistance from the Ohio State Medical Association.
OSMA regularly works with the health department to ensure Ohio physicians and patients are involved in health care decisions being made across the state, including RHT, according to CEO Todd Baker.
The RHT proposal includes a series of larger projects, and within those are specific components that will improve access to maternal care. One of the largest aspects of the proposal includes an effort to increase the number of health care workers in rural areas.
“That, in and of itself, is going to create the opportunity for expanding the kinds of health care professionals that provide maternal health care,” Baker said. “While it doesn't specifically mention defined types of workforce, (the proposal is) talking about creating opportunities to increase the workforce throughout the health care continuum in rural areas.”
The plan includes a series of initiatives that will improve access to rural Ohioans, including those that address the maternity desert crisis, according to the program’s project narrative.
“Addressing maternity deserts with legislative change and support to rural hospitals who will have the opportunity to add quality, low-cost birthing centers operated by general practitioners and midwives for mothers with anticipated health deliveries,” the project narrative said. “This initiative prevents unnecessary, sometimes long drives to hospitals away from the mother’s home, while also leveraging the knowledge and skills of local practitioners and rural hospitals.”
In Ohio, residents living in maternity deserts must travel 1.9 times farther to reach a Title X clinic than residents living in low-vulnerability counties, according to March of Dimes. These clinics are defined as “federally funded health care sites that provide low-cost reproductive health care services including contraceptives, wellness exams and breast and cervical cancer screenings.”
There are only five of these clinics in Southeast Ohio, including Planned Parenthood of Greater Ohio, AthensHealth Center in Athens County, Gallia County General Health District in Gallia County, Lawrence County Health Department in Lawrence County, Family Health Services of East Central Ohio in Perry County and Portsmouth City Health Department in Scioto County.
The plan also calls for an increase in high-quality home visiting services in rural communities to "improve outcomes for pregnant women and their children” while “providing babies with the healthiest start in life and preventing maternal and infant mortality.”
“The idea is to look at existing programming, existing initiatives and really try to amplify those,” Baker said. “Part of the goal is to look at existing types of initiatives and say, ‘How can we fund those at an even greater level?’”
Although access to maternal care is a persistent challenge in Southeast Ohio, growing investments in resources, partnerships and community initiatives are beginning to close the gap toward equitable maternal health care.
ah875121@ohio.edu sp249021@ohio.edu rs848622@ohio.edu gn875322@ohio.edu dg422421@ohio.edu
