Employees outside Nashoba Valley Medical Center shuttered all of its units in 2024, including labor and delivery. —David L. Ryan/The Boston Globe—Getty ImagesIn the last eight years, women living in counties in one-third of the country have faced an abysmal reality: they live in a maternity care desert, which means a place where there are no hospitals or birth centers or even any obstetric clinicians. That reality has persisted: in its new 2026 report on women’s access to ob-gyn services, released on August 11, the March of Dimes found that 34.6% of U.S. counties are maternity care deserts, and that more than half of U.S. counties lack a hospital with labor and delivery services. That’s relatively unchanged since 2016, the report found. But the situation is likely to soon get even worse, experts say. H.R. 1, known as the One Big Beautiful Bill Act, which was signed into law on July 4, 2025, is expected to dramatically cut payments to Medicaid as well as introduce burdens that make it more difficult for people to stay on Medicaid. Medicaid already reimburses hospitals at a lower rate than services cost; on average, Medicaid paid hospitals $8,732 less for childbirth services than did employer-sponsored health plans, one 2022 study found. Meanwhile, the expiration of subsidies for Affordable Care Act plans have led to more uninsured patients visiting emergency rooms, challenging some hospitals’ financial status. “It is going to be very challenging for rural hospitals to remain viable,” says Dr. Michael Warren, chief medical officer of the March of Dimes. “That is going to further exacerbate the patterns that we're already seeing, where these maternity care deserts tend to be concentrated in rural communities.” Why maternity care deserts happenA 2025 analysis from the National Partnership for Women and Families found that 131 rural hospitals across the country with labor and delivery units were at risk of closure or severe service cutbacks because of H.R. 1. Maternity care deserts happen because of a few factors. Ob-gyn services often lose money for hospitals because they have to be staffed with medical providers, including anesthesiologists, around the clock. In rural areas with low birth rates, hospitals have to spend the money to keep obstetric units staffed and open, even when there are relatively few births generating revenue. And because rural areas have high shares of patients on Medicaid, the hospitals also don’t receive adequate reimbursement. “It’s sort of a double whammy,” Warren says. “Their birth volume is low, so they have fewer folks coming through to make those payments, but also, when they do get those payments, it's likely to be lower because it's more likely to be Medicaid.”Maternal care deserts aren’t just in rural areas. Some urban and suburban hospitals have also had to close their labor and delivery units because of cost or because they can’t find enough staff. Those staffing shortages are also expected to increase. Today, the majority of rural counties—57.9%—lack a practicing obstetric clinician, the March of Dimes found. But by 2035, all but six states are projected to have an inadequate supply of obstetric clinicians, according to a recent study that used data from the Health Resources & Services Administration.Maternity care deserts lead to worse outcomes for both mother and baby, Warren says. When women have to travel further to receive care, they often miss prenatal appointments, which means problems may not be diagnosed in time. They sometimes have to skip postpartum appointments, even though the majority of pregnancy-related deaths occur postpartum, he adds. Having to drive farther to deliver a baby means that women with dangerous pregnancies may not get care until it’s too late. Some bleeding episodes in pregnancy have to be addressed quickly, says Dr. Lisa Bukovac, chief clinical officer at OB Hospitalist Group, which partners with hospitals to help deliver babies. “In obstetrics and all specialties,” she says, “minutes count.”