The Crisis in American Maternal Health: How Hospital Closures, Workforce Shortages, and Rural Deserts are Threatening Mothers and Infants

Main Facts

The United States is facing a profound maternal health emergency. Each year, between 650 and 700 women lose their lives to pregnancy-related causes, while an estimated 60,000 others suffer from severe maternal morbidity—defined as unexpected labor and delivery outcomes that leave victims with debilitating short- or long-term health consequences. According to data from the Centers for Disease Control and Prevention (CDC), more than 80% of these pregnancy-related deaths are entirely preventable with timely, appropriate medical intervention.

Compounding this mortality and morbidity crisis is a nationwide structural collapse in perinatal care access. Between 2010 and 2023, 641 hospital labor and delivery units shuttered their doors across the United States. This relentless wave of closures has created widespread maternity care deserts, leaving vast stretches of the country—particularly rural and low-resource regions—without local access to obstetric services.

When a birthing facility closes, the repercussions ripple outward immediately. Patients are forced to travel significantly greater distances to receive essential prenatal, delivery, and postpartum care. This geographic displacement drastically elevates risks for both mothers and newborns. Furthermore, as local maternity units disappear, pregnant individuals increasingly rely on non-traditional and emergency settings for obstetric care, turning to hospital emergency departments and emergency medical services (EMS) personnel who may lack specialized training or equipment.

Mirroring these national trends, Colorado has emerged as a microcosm of the fragile American healthcare ecosystem. Currently, 40% of Colorado counties are classified as maternity care deserts, and a staggering 98% of the state’s population lives in an area with an inadequate supply of prenatal health care. To combat this crisis, the Colorado Department of Public Health and Environment (CDPHE) commissioned JSI, a public health research and consulting organization, to conduct a comprehensive study examining rural perinatal access and the direct impacts of birth facility closures.

The resulting study exposed deep vulnerabilities in emergency and routine obstetric readiness, prompting a series of legislative recommendations designed to overhaul Colorado’s perinatal care network. Nationally, initiatives like the Alliance for Innovation on Maternal Health (AIM)—a HRSA-funded program managed by JSI—are working to bridge these gaps by implementing evidence-based patient safety bundles across thousands of hospitals and alternative care settings.

Chronology

To understand how the American perinatal care system reached its current tipping point, it is necessary to examine the timeline of systemic erosion, legislative intervention, and policy response:

• 2010–2023: A prolonged, nationwide contraction of rural and community healthcare infrastructure results in the closure of 641 hospital labor and delivery units across the United States. Economic pressures, declining rural birth rates, and severe workforce shortages drive hospitals to shutter profitable or unprofitable maternity wards alike, sparking the modern perinatal access crisis.
• Early 2020s: States across the American West and Midwest—including Colorado—begin experiencing rapid waves of rural hospital downsizing and closures. The geographic safety net for pregnant individuals frays significantly, leaving expansive rural counties completely devoid of local obstetric care.
• 2025: Recognizing the escalating threat to mothers and infants, the Colorado Department of Public Health and Environment (CDPHE) formally engages JSI to investigate the localized impacts of birth facility closures on rural perinatal care networks.
• 2025 (Study Execution & Findings): JSI researchers interview health providers, emergency responders, and impacted community members throughout Colorado. The investigation reveals that the primary consequence of facility closures is extreme travel times—compounded by severe weather, treacherous mountain passes, and wildlife hazards. The study also documents the dangerous shift of obstetric emergencies onto underprepared emergency departments and EMS crews.
• Post-Study (Legislative Reporting): Following the completion of the research, JSI authors a comprehensive legislative report for Colorado policymakers. The document outlines actionable recommendations, best practice guidelines, and proposed steps to fortify the state’s perinatal system, protect vulnerable populations, and establish emergency readiness standards.
• Ongoing (National Implementation): Nationally, the AIM Technical Assistance Center—managed by JSI—expands its reach to over 2,095 birthing facilities (representing 74% of all U.S. hospitals with maternity services) across 51 states and jurisdictions. The program rolls out specialized resource kits, such as the AIM Obstetric Emergency Readiness Resource Kit and the AIM Community Birth Transfer Resource Kit, to address non-obstetric and low-resource care gaps.

Supporting Data

The severity of the maternal health crisis is underscored by a compelling body of statistical evidence collected by federal agencies, public health researchers, and state assessments:

• 650 to 700: The approximate number of annual pregnancy-related deaths in the United States.
• 60,000: The number of U.S. women annually affected by severe maternal morbidity, facing unexpected labor and delivery complications with serious health implications.
• >80%: The proportion of pregnancy-related deaths that the CDC estimates are entirely preventable with timely diagnosis and quality medical care.
• 641: The total number of hospital labor and delivery units that closed nationwide between 2010 and 2023, accelerating the perinatal care access crisis.
• 40%: The percentage of Colorado counties currently designated as maternity care deserts as a result of recent birth facility closures.
• 98%: The share of Colorado residents who now live in geographic regions with an inadequate supply of prenatal health care.
• 2,095+: The number of U.S. birthing facilities (accounting for 74% of all maternity hospitals nationwide) currently implementing evidence-based patient safety bundles through the AIM initiative.

Official Responses

Public health officials, researchers, and legislative experts have sounded the alarm regarding the systemic collapse of maternity care and have put forward concrete strategies for reform.

Caitlin Hungate, Senior Associate at JSI and co-investigator and co-author of the Colorado study, emphasized the profound logistical and financial hurdles faced by families in rural areas. "Study participants shared that the primary consequence of a birth facility closure was increased travel time to care," Hungate explained. "In rural Colorado, that is often exacerbated by weather, mountain passes, and wildlife on the roads. The increased travel time can be financially and logistically burdensome for women and families, given transportation needs and the implications on childcare and employment leave time."

Furthermore, Hungate and her research team highlighted how closures disrupt the entire emergency medical ecosystem. The study revealed that when local labor and delivery wards shut down, the immediate burden of obstetric emergencies shifts onto hospital emergency departments and local emergency medical services. In many cases, these frontline entities are severely underprepared to manage childbirth complications, often lacking staff with specialized clinical training in labor and delivery, as well as necessary emergency equipment.

In response to these findings, the legislative report authored by JSI lays out a proactive roadmap for Colorado lawmakers and healthcare administrators. The official recommendations focus on building systemic resilience and workforce readiness, specifically calling for:

1. Ongoing Simulation and Training: Implementing regular, rigorous clinical simulations for emergency department personnel and first responders to effectively manage unexpected obstetric emergencies, such as unassisted emergency department births or high-risk emergency transfers.
2. Targeted Equipment Funding: Allocating state resources and grants to secure specialized medical equipment necessary for managing obstetric and neonatal crises in non-traditional settings.
3. Cross-Sector Coordination: Fostering robust collaboration and formal communication channels between community-based birth providers—such as licensed midwives—and local emergency medical services to streamline patient transfers from home or birth center settings to acute-care hospitals.

On a national level, federal backing of the Alliance for Innovation on Maternal Health (HRSA-funded) continues to serve as a primary vehicle for clinical quality improvement. By deploying standardized safety bundles and specialized toolkits like the AIM Obstetric Emergency Readiness Resource Kit and the AIM Community Birth Transfer Resource Kit, public health leaders are equipping low-resource facilities and emergency departments with the protocols needed to save lives.

Implications

The cascading closure of birthing facilities and the concurrent deterioration of perinatal access carry profound, long-term implications for American society, healthcare economics, and individual families.

First and foremost, the erosion of local maternity care directly threatens maternal and infant survival rates. When pregnant women must travel hours across rural landscapes—navigating geographic barriers like mountain ranges and adverse weather—the window for treating catastrophic complications such as postpartum hemorrhage, eclampsia, or placental abruption narrows dangerously. Delays in care transform manageable obstetric emergencies into fatal or life-altering tragedies.

Second, the shifting of obstetric care onto emergency departments and EMS personnel places an unsustainable strain on healthcare workers who are already operating under intense nationwide workforce shortages. Expecting emergency room physicians, nurses, and rural paramedics to deliver babies and manage complex neonatal resuscitations without adequate specialized training or equipment creates an environment ripe for medical error and professional burnout.

Third, the financial and social toll on families is immense. The hidden costs of traveling long distances for routine prenatal care include lost wages, expensive fuel, extended time away from employment, and complex childcare arrangements for older siblings. For low-income and marginalized families, these hurdles frequently result in delayed or skipped prenatal visits, compounding underlying health risks and entrenching health disparities.

Ultimately, the findings from Colorado and the broader national landscape demonstrate that America’s perinatal care crisis cannot be solved by simply absorbing closures into existing emergency workflows. Policymakers, healthcare systems, and community leaders must prioritize strategic investments in rural health infrastructure, workforce training, and cross-sector coordination. By establishing robust emergency readiness protocols and supporting initiatives like AIM, the healthcare community can build a resilient safety net that ensures safe, reliable, and equitable care for every mother and child, regardless of zip code.