Rural U.S. faces growing maternity care deserts despite falling fertility rates

Pregnant women in many rural parts of the United States often must travel two hours or more to reach a hospital that can deliver a baby, putting them at risk if labor starts early or complications arise.

Although the national fertility rate has dropped by about 23% over the last twenty years, the shortage of obstetricians and gynecologists is not easing. Nearly half of U.S. counties now lack a practicing OB‑GYN, creating what experts call maternity care deserts.

South Dakota illustrates the paradox: it maintains one of the country’s higher fertility rates, yet more than half of its counties are classified as maternity deserts, with no hospitals or birth centers offering obstetric services.

The authors, senior medical educators, argue that the crisis stems from how physicians are trained and deployed rather than a lack of medical knowledge or technology.