Over Half of U.S. Counties Have No Maternity Care. Black Mothers Pay the Price.

Nadia Gramby drives 300 miles in a day across Alabama to care for pregnant women. She shouldn't have to.

According to NPR's reporting on the latest March of Dimes "Nowhere to Go" report, more than half of U.S. counties have no hospital-based labor and delivery services. One in three counties has no birthing facilities or obstetric clinicians at all. These "maternity deserts" aren't accidents of geography. They're the predictable result of a healthcare system that abandons places where there's no profit to be made.

The human cost is real. Black women face maternal death rates nearly three times higher than white women. About 600 women die annually from pregnancy-related complications in the wealthiest country on earth. When you live in a county with no maternity services, your odds of a bad outcome skyrocket.

Gramby, a licensed and certified professional midwife, founded Crown of Glory Birth Services in 2018 to serve women in care deserts. She's one of only 1,200 Black midwives in the U.S., a number that itself tells you something. Midwives are trained, licensed professionals, yet the system treats them as a stopgap instead of essential healthcare workers. Gramby is doing heroic work. But heroism shouldn't be the plan.

This Is What Healthcare for Profit Looks Like

Hospital systems close labor and delivery units when they're not "profitable enough." Rural hospitals shut down. Insurance companies deny coverage for midwife-led care in many states. Pregnant women drive hours for prenatal checkups. Some don't make it in time.

The reason? Healthcare as a commodity, not a right. When a hospital calculates that delivering babies in rural Alabama won't generate enough revenue, it closes the unit. No hospital board answers to the women who lose access. They answer to shareholders.

This hits Black mothers hardest. Systemic racism compounds the access problem. Black women are more likely to live in underserved areas, face discrimination from providers, and carry the stress of navigating a system built to undervalue their lives. Gramby's practice is essential care, but it shouldn't require one woman to cross an entire state to fill a gap that the system created.

What Actually Works

Countries with universal healthcare, Canada, Germany, Japan, every wealthy democracy, don't have maternity deserts. They guarantee access to prenatal care, labor and delivery, and postpartum support as a public health investment. No one drives 300 miles for a prenatal appointment because the system isn't built on profit margins.

Midwife-led care, when supported and integrated into healthcare systems, produces better outcomes and costs less than hospital-only models. But in America, we don't fund what works. We fund what's profitable.