Education Blog

Pregnant and No Access to Care: Taking on America’s Maternity Care Deserts

September 16, 2021

This Maternity Care story was created in partnership with Reckitt’s Enfa brand portfolio.

Many people find the months leading to childbirth a blur of planning and preparation. Regular appointments are made with obstetricians as well as prenatal care teams to ensure that baby and mom are healthy. There are usually classes on parenting, nutrition, birthing, breastfeeding, and nutrition for the first baby. Sessions with a certified doula might be offered to help on the birthday. Meetings with other parents-to-be to talk about the emotional rollercoaster of having a baby.

However, no matter what the details, many parents consider a baby’s birth a well-planned event. Imagine if you didn’t have a trusted OB. Imagine that none of those classes are offered in your area and that no doulas are available.

This is unfortunately the reality for millions of American women who become pregnant without receiving quality prenatal care. How did we get to this point? What can we do to provide care for all expecting moms in the United States of America?

How Maternity Care Deserts came to be

The United States currently has 2.2 million women who live in maternity care deserts, which is a state that offers no access to healthcare during pregnancy. Also, this means that there are no prenatal care centers, no birth centers and no obstetricians in these areas. Another 4.8 million women reside in areas with very limited maternity care options. These 7 million women are responsible for delivering 500,000 babies each year in the U.S. Each year. However, they don’t have the same medical support system that women who live near hospitals or other medical centers with OB/GYNs. This creates unique challenges during their pregnancies.

The US’s poor maternal care system affects many. A woman dies, every 12 hours, due to pregnancy-related causes. The maternal mortality rate in America has risen to twice that of other countries, including four times more than Sweden and five times higher than Germany.

Stacey D. Stewart is President and CEO of March of Dimes. March of Dimes is a national nonprofit. It is dedicated to improving the health of mothers, babies, and their families. Stewart stated that mothers and babies are in urgent need of us now more than ever in the introduction to Nowhere to Go 2020: Maternity Care deserts Across America’s 2020 report. Stewart said, “We face a serious maternal and infant health crisis which has only increased with the COVID-19 epidemic.”

Mobilizing to Help Maternity Care Deserts

March of Dimes and Reckitt’s Enfa brands teamed up to create Better Starts For All. The multi-year initiative aims to support pregnant women in rural areas. That is where maternity care needs improvement. Multi-faceted, the campaign includes a digital destination for women to sign up to get peer support and provider services. A mobile clinic bus will also be available for a boots-on-ground approach.

The bus is currently in Washington, D.C. The second rollout in Southeast Ohio is planned for the next few weeks. Dr. Abra Greenberg is a female health nurse with over 15 years of experience. “Our biggest problem with southeast Ohio’s vast space,” she says. After learning about March of Dimes’ mission and feeling inspired to make a difference, she joined March of Dimes a year back. She says, “Our mobile bus is located in Jackson County, where there are not many OB/GYN providers in the entire county.” “Women must drive for up to an hour to receive care.”

Mobile Maternity Care

The mobile maternity bus’s goal is to provide direct medical assistance to pregnant women in their community. Greenberg says that certified nurse-midwives are available to them on the bus. It also says that if a woman is high-risk, they offer a telehealth option so she can get help there.

It’s also said, “We are there to help them connect with social workers and Medicaid, food pantries and behavioral and mental healthcare services, and so forth.” “Southeast Ohio is experiencing a rising epidemic of substance abuse disorder. We have the resources to help them.”

Greenberg says that the Ohio Better Starts for All mobile medical clinic is fully operational. She says, “It has an open area for people to check in and exchange information. There are also two private exam rooms where providers can see women.” “We will have certified nurse-midwives, medical assistants, and four to six total staff who can see women on board the bus.

Greenberg recognizes that telehealth can be a great option for patients at high risk. However, poor internet connectivity in rural Ohio may make it difficult. She says, “My calls are dropped four to five times per day out here.” “This is why the mobile bus is so crucial.”

Mobile Clinics and More

Mobile clinics are a great option for rural areas, where there is literally no obstetrician within a few miles. It also serves an important function in urban areas with low income where there are fewer hosptials.

This is what happens in Wards 7 & 8 in Washington, D.C., which Billie Hamilton Powell, a certified nurse-midwife, serves as Director of Mobile Health for the University of Maryland Capital Region Health. She partners with March of Dimes, Better Starts for All, and the Mama & Baby Bus to provide mobile health access.

She told us about the closing of several hospitals in these areas in the past few years. “Women have been denied access to maternal healthcare.” In urban D.C., unlike Ohio’s Jackson County, the problem is not the distance women must travel to receive care, but logistics. She explains that it’s not about the cost of travel but how to get from your house to the city to see a provider. There is no simple way to get there. So, how much are you willing to pay for Uber? Which option are you going with if you have no money to pay for Uber or food for your family tonight?

She also points out that for mothers with young children, it can be difficult to spend half of the day driving from one end to another to see a doctor. Do you take them along? She asks, “Do you need to pay for their transportation?” “Women won’t seek prenatal care because it’s too expensive,” she says.

Hamilton-Powell’s Better Starts for All mobile clinics park at locations that have been identified for high foot traffic. “We consider things such as where do these women go most often? Churches equipped with food banks? Shopping centers? She says that if we place our buses in areas outside of their comfort zone, they won’t come.” We need to meet them wherever they are comfortable. We’ve even parked outside apartment complexes.”

There is a clear need:

Although the clinics will see eight women per day, Hamilton-Powell states that they could see up to 12, depending on where they are located. And there are waiting lists available for those who wish for appointments. She says, “The goal of the clinics is to see as many women in their pregnancy as possible.” “The earlier we identify potential complications, the better their pregnancy will be.”

What the Future Has in Store for Expecting Mothers

Moreover, Better Starts for All offers a number of key programs, including the Becoming a Mom Course, a nine-week course that is free and led by a certified health educator. It teaches important topics about pregnancy and allows expecting mothers to connect with other families in the area.

Greenberg, who has facilitated these workshops, says that it’s a way to learn and share. “There was one woman with a high-risk pregnancy. She wasn’t certain if she could give birth in her local hospital, or if she would have to travel two hours to get there. This uncertainty is extremely stressful. The group offered support and guidance to other women in her situation.

Greenberg hopes to connect pregnant women who visit the mobile clinic with this support program. She says, “Our focus is to provide care and wraparound resources for women who don’t know where it is.” We can help you, whether you’re pregnant after a miscarriage or expecting your first child. We won’t turn anyone away.”

To learn more about Better Starts for All and to find programs in your area, please visit or follow the organization on Instagram at @betterstarts4all.