Access to maternity care in the United States is facing a crisis, with rural communities and regions like North Texas bearing the brunt of declining services and funding setbacks. Two recent developments—one a sweeping national study and the other a local funding battle—underscore the mounting challenges facing mothers, newborns, and health care providers across the country.
According to a University of Minnesota School of Public Health study, access to obstetric care has steadily eroded from 2010 to 2022, with rural hospitals hit the hardest. The research, which examined nearly 5,000 short-term, acute care hospitals in all 50 states and the District of Columbia, found that the closure of obstetric units has continued even after the implementation of national policies intended to preserve these vital services. The Improving Access to Maternity Care Act, passed in 2018, was supposed to help stem the tide, but the data shows that closures persisted through 2022.
The numbers are stark: by the end of 2022, two-thirds of rural hospitals in eight states no longer offered obstetric services. In states like Pennsylvania, South Carolina, West Virginia, and Florida, more than 40% of rural hospitals had lost these units. North Dakota and Oklahoma saw particularly severe losses, with 73% and 63% of their hospitals, respectively, lacking obstetric care by 2022. Some states, such as Delaware, Utah, and Vermont, managed to avoid any closures during the period, but they were the exception rather than the rule.
“Obstetric unit closures can increase distance to care and put pregnant patients and newborns at risk,” said Dr. Katy Backes Kozhimannil, lead author of the University of Minnesota study, in an interview with the Daily Yonder. “Our analysis revealed wide variability across states in obstetric care losses and highlighted the growing access challenges faced by people living in rural communities and highly rural states.”
The study also highlighted the uneven impact of Medicaid expansion. While expanding Medicaid delayed some obstetric unit closures, it did not prevent them. Kozhimannil explained, “Medicaid is such an important payer in rural healthcare, and it’s obviously like the top payer for births in rural areas and across the US. Medicaid and Medicaid financing and Medicaid policy are very important. But a Medicaid policy like Medicaid expansion, which focuses on the low-income childless adult population, was not targeted enough to specifically affect the financing for rural maternity care.”
Dr. Eileen Thrower, department chair for Frontier Nursing University’s Department of Midwifery and Women’s Health, told the Daily Yonder that the lack of access in rural areas has been worsening since she began her career in 1990. As a result, patients are increasingly turning to telehealth and nurse practitioners for prenatal and postpartum care. However, Thrower pointed out, “In terms of maternity care, the problem is that midwives are often going to be located where they can do births in a hospital. And if a hospital or a labor and delivery unit has closed in a rural area, midwives don’t tend to be able to stay there because they also can’t do the birth.”
The impact of these closures is not just a matter of inconvenience; it can be life-threatening. “I’m afraid the impact that we see and that we know is documented is that in rural settings, folks are less likely to be able to receive adequate prenatal care which is really tied to poorer outcomes,” Thrower said. “And they’re also then traveling further for birth, which is, if you’ve got to drive an hour or two or more to get to the hospital, things can happen on that travel. There’s more risk there.”
The consequences of these trends are reflected in a study published in August 2025 in Obstetrics & Gynecology, which found that maternal health outcomes in the U.S. have worsened by 89% since 2018, with structural inequities in health care access—especially in rural and underserved areas—driving much of the increase. The study noted, “A key determinant of maternal health is the availability of qualified maternity care practitioners, including obstetricians, gynecologists, and certified nurse–midwives. Previous studies suggest that adequate access to these practitioners improves outcomes such as preterm birth, preeclampsia, and neonatal outcomes. Their uneven distribution has created gaps in care, with up to 40% of rural counties lacking maternity care practitioners.”
While the national picture is grim, local efforts to combat the crisis have faced their own setbacks. On August 28, 2025, it was reported that the federal government had cut a $15 million grant intended to reduce maternal morbidity in North Texas. The grant, awarded to the North Texas Maternal Health Accelerator—a coalition led by the Burnett School of Medicine at Texas Christian University (TCU) and UT Southwestern and managed by the Child Poverty Action Lab—was part of the Health Care Rewards to Achieve Improved Outcomes (HEROES) program under the Advanced Research Projects Agency for Health (ARPA-H). The program had $100 million to allocate nationwide, and the North Texas proposal had won the maximum funding available.
The coalition, which began operating in December 2024 with $17.5 million in foundation commitments, had also raised over $20 million in matching funds from 11 Texas-based partners. The Arlington Tomorrow Foundation recently committed $1 million to help launch a postpartum hypertension management program in Arlington. The goal of the accelerator was ambitious: reduce childbirth complications by 20% over the next three years and develop a sustainable, scalable model to improve maternal health.
But the federal cuts, which sacrificed $200 million of local investment nationally, have left local officials scrambling. “This is hard news, but the response has been truly inspiring and a testament to the commitment and the power of regional coalition-making,” Cameron Combs, director of the maternal health accelerator, said in a statement to the Fort Worth Report. “We’re going to keep the foot on the gas.”
Local leaders, including Tarrant County officials and Governor Greg Abbott, have been working to reverse the funding cuts. However, Abbott’s office noted that any replacement of federal dollars with state funds would require action by state lawmakers—a process that remains uncertain. State Rep. Charlie Geren, R-Fort Worth, told POLITICO Pro he was unaware of the cuts and declined to comment.
Despite the setback, the region’s efforts to improve maternal and infant health continue. Led by Mayor Mattie Parker, local organizations launched the Tarrant County Maternal & Infant Health Coalition in 2022, bringing together 16 entities to improve access to resources. Initiatives have included distributing iron pills to expecting mothers free of charge and improving direct communication between mothers and their care teams. “There are countless individuals and organizations invested in our mission and working tirelessly to create real impact in our community for years to come, and we will use this momentum to continue improving the health and well-being of our moms and babies in North Texas,” Parker said in a statement to the Fort Worth Report.
Experts and advocates agree that reversing the decline in maternity care access—whether in rural America or fast-growing urban regions—will require targeted funding, creative solutions, and sustained political will. As Dr. Kozhimannil put it, “For policy makers, the solutions really need to be targeted toward maternity care financing to ensure access to and preservation of maternity care access.” The stakes, as the studies and local stories make clear, could not be higher for the nation’s mothers and children.
