Maternity care deserts across the US — 2024 report
March of Dimes documents counties with no obstetric providers and rising infant mortality.
OVUM Editorial·
Executive summary
March of Dimes documents counties with no obstetric providers and rising infant mortality. Executive Summary Maternity care deserts—counties lacking obstetric services—are expanding across the US, creating a $10B+ market opportunity for telehealth, remote monitoring, and distributed care models. OVUM reads this as a category signal for maternal-care access, outcomes, and delivery models, with implications for product strategy, coverage design, and capital allocation.
Key findings
- Executive Summary Maternity care deserts—counties lacking obstetric services—are expanding across the US, creating a $10B+ market opportunity for telehealth, remote monitoring, and distributed care models.
- As of 2024, 60% of US counties lack obstetric services; 43M women live in maternity care deserts.
- This crisis is driven by three forces: (1) OB/GYN workforce shortage (declining residency applications, rural exodus), (2) hospital consolidation reducing obstetric capacity, and (3) liability and reimbursement pressures forcing rural hospitals to close maternity units.
- Innovative care models—virtual prenatal care, remote fetal monitoring, midwifery-led care, and community health worker integration—are filling gaps.
Market implications
- Maternal outcomes are becoming a board-level risk metric for health systems, payers, and public agencies — not solely a clinical quality issue.
- Access gaps, especially in maternity deserts, create structural demand for hybrid, home-based, and midwifery-led models with reimbursement pathways.
- Doulas, community health workers, and remote-monitoring infrastructure are shifting from pilots to line-items in benefit design.
Interpretative layer
Professional access includes investor relevance, OVUM view, and category-level implications.
Source and methodology
Synthesized from the published article, its classification metadata, and OVUM's internal market taxonomy. Last indexed Jun 12, 2026.
Full analysis
Executive Summary Maternity care deserts—counties lacking obstetric services—are expanding across the US, creating a $10B+ market opportunity for telehealth, remote monitoring, and distributed care models. As of 2024, 60% of US counties lack obstetric services; 43M women live in maternity care deserts. This crisis is driven by three forces: (1) OB/GYN workforce shortage (declining residency applications, rural exodus), (2) hospital consolidation reducing obstetric capacity, and (3) liability and reimbursement pressures forcing rural hospitals to close maternity units. Innovative care models—virtual prenatal care, remote fetal monitoring, midwifery-led care, and community health worker integration—are filling gaps. Companies addressing maternity deserts span telehealth (Ro, Nurx, Tia), maternal health platforms (Pomelo Care, Maven Clinic, BrightHeart), perinatal mental health (Postpartum Support International, Mindstrong), and remote monitoring (Nirapad, Babyscripts). The regulatory environment is favorable (CMS expanding telehealth reimbursement, states licensing midwives), creating opportunities for platforms that improve access and outcomes in underserved regions.
Part 1: The Maternity Care Desert Crisis Scale of the Problem 60% of US counties lack obstetric services (2024) 43M women live in maternity care deserts Maternal mortality rate: 17.9 deaths per 100,000 live births (2024); highest among developed nations Racial disparities: Black women 2.6x more likely to die from pregnancy-related causes; Hispanic women 1.6x more likely Rural impact: Rural counties 3x more likely to lack obstetric services; rural maternal mortality 1.5x higher than urban Causes of Maternity Care Deserts OB/GYN Workforce Shortage - Declining residency applications in obstetrics (down 15-20% over past decade) - Rural exodus: 80% of OB/GYNs practice in urban/suburban areas - Burnout and liability concerns driving early retirement - Maldistribution: 50% of OB/GYNs concentrated in 10% of counties Hospital Consolidation - Large health systems closing rural maternity units (cost-cutting) - Consolidation reduces obstetric capacity in underserved regions - Centralization increases travel distance for pregnant women (average 50+ miles in deserts) Reimbursement and Liability Pressures - Medicaid reimbursement rates insufficient for rural hospitals - Malpractice insurance costs prohibitive for small hospitals - Low volume + high costs = unsustainable economics for rural maternity units Economic Impact - Pregnant women forced to travel 50-200+ miles for prenatal care and delivery - Increased risk of adverse outcomes (preterm birth, maternal complications) - Estimated cost to healthcare system: $10B+ annually in preventable complications
Part 2: Telehealth and Virtual Prenatal Care Virtual Prenatal Care Platforms Ro (telehealth platform): - Expanded into prenatal care and pregnancy support - Virtual OB/GYN consultations - Prescription fulfillment and medication delivery - Addresses access gap in maternity care deserts - Growth-stage; expanding maternal health offerings Nurx / Thirty Madison (telehealth + pharmacy): - Originally contraception and sexual health focused - Expanding into prenatal care and pregnancy support - Virtual consultations + prescription delivery - Addresses reproductive health continuum (contraception → pregnancy → postpartum) Tia (hybrid virtual + brick-and-mortar): - Virtual + in-person women's health clinics - Prenatal care, OB/GYN, primary care, mental health - Expanding into underserved regions - Hybrid model enables access in areas lacking in-person capacity Maven Clinic (full-stack women's health): - Maternity care module (prenatal, labor support, postpartum) - Virtual care + mental health + lactation support - Employer and payer partnerships - Thousands of employers; enables scale in underserved regions Pomelo Care ($92M Series C, $1.7B valuation Jan 2026): - Maternity and women's health services - Virtual + in-person care model - Rapid growth; expanding into underserved markets - Highest-funded maternal health startup; demonstrates market validation BrightHeart (€11M Series A, Sofinnova lead): - AI-powered prenatal ultrasound (fetal cardiac defect detection) - Addresses diagnostic gap in underserved regions - Remote interpretation enables access without specialist on-site - Demonstrates how AI can extend specialist expertise to deserts Advantage: Virtual care removes geographic barriers; enables access in maternity deserts; reduces travel burden on pregnant women.
Part 3: Remote Monitoring and Distributed Care Models Remote Fetal Monitoring Babyscripts (remote monitoring platform): - Wearable fetal monitoring devices - Remote interpretation by OB/GYNs - Enables continuous monitoring without in-person visits - Reduces need for frequent clinic visits - Particularly valuable in maternity deserts Nirapad (remote maternal monitoring): - Wearable sensors for maternal vital signs monitoring - Enables early detection of preeclampsia and other complications - Remote interpretation by healthcare providers - Reduces need for frequent in-person monitoring Advantage: Remote monitoring enables continuous care without geographic barriers; early detection of complications; reduces travel burden. Midwifery-Led Care Models Midwifery Expansion: - Certified nurse midwives (CNMs) and certified midwives (CMs) can provide prenatal care and delivery - 12 states have licensed direct-entry midwives (LDEMs) - Midwifery-led care reduces costs by 20-30% vs OB/GYN-led care - Outcomes comparable to OB/GYN-led care for low-risk pregnancies Community Health Worker Integration: - Community health workers (CHWs) provide prenatal education, support, and navigation - Reduces maternal mortality by 15-20% in underserved communities - Cost-effective: CHWs earn $30K-40K vs $200K+ for OB/GYNs - Addresses social determinants of health (transportation, housing, food security) Advantage: Midwifery and CHW models reduce costs, improve access, and address social determinants of health.
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Part 4: Perinatal Mental Health Platforms Perinatal Mood Disorder Crisis 1 in 7 women experience postpartum depression 1 in 10 women experience postpartum anxiety Maternal suicide is leading cause of pregnancy-related death Perinatal mental health services severely underfunded and undersupplied Perinatal Mental Health Platforms Postpartum Support International (PSI): - Non-profit providing perinatal mental health support - Helpline, support groups, provider directory - Training programs for healthcare providers - Advocacy for perinatal mental health policy - Addresses critical gap in perinatal mental health access Mindstrong (mental health platform): - Digital mental health platform with perinatal focus - Screening, assessment, and treatment for perinatal mood disorders - Integration with OB/GYN care - Addresses mental health as critical component of maternal health Talkspace (telehealth mental health): - Therapy and psychiatry via app - Perinatal mental health specialists available - Partnership with Evernow (menopause) demonstrates integration potential - Enables mental health access in underserved regions Little Journey (£6M funding, perinatal mental health): - Digital health for pediatric hospital anxiety and maternal mental health - Addresses maternal anxiety and postpartum depression - UK-based; demonstrates international market opportunity - Emerging platform addressing critical gap Advantage: Perinatal mental health platforms address leading cause of pregnancy-related death; improve maternal outcomes; reduce healthcare costs.
Part 5: Maternal Health Diagnostics and Monitoring Prenatal Screening and Diagnostics Natera (prenatal diagnostics): - Non-invasive prenatal testing (NIPT) for genetic abnormalities - Expanded carrier screening - Enables early detection of fetal abnormalities - Reduces need for invasive testing (amniocentesis) Illumina (genomic sequencing): - Prenatal genomic testing - Enables comprehensive fetal health assessment - Reduces need for multiple tests - Improves diagnostic accuracy Advantage: Advanced diagnostics enable early detection; reduce need for invasive testing; improve outcomes. Maternal Vital Signs Monitoring Nirapad (remote maternal monitoring): - Wearable sensors for maternal vital signs - Early detection of preeclampsia, gestational diabetes, other complications - Remote interpretation enables access in deserts - Reduces need for frequent in-person monitoring Babyscripts (remote fetal monitoring): - Wearable fetal monitoring - Remote interpretation by OB/GYNs - Enables continuous monitoring without in-person visits - Particularly valuable in maternity deserts Advantage: Remote monitoring enables early detection of complications; reduces travel burden; improves outcomes.
Part 6: Maternal Health Equity and Social Determinants Addressing Racial and Ethnic Disparities Comanche Biopharma ($136M Series B, preeclampsia treatment): - Developing siRNA therapy for preeclampsia - Addresses serious pregnancy complication disproportionately affecting Black women - Phase 2 clinical development - Demonstrates how therapeutics can address maternal health disparities Community Health Worker Programs: - CHWs from same communities as pregnant women - Address social determinants (transportation, housing, food security, childcare) - Reduce maternal mortality by 15-20% in underserved communities - Cost-effective: $30K-40K vs $200K+ for OB/GYNs Doula and Birth Worker Integration: - Doulas provide continuous labor support - Reduce cesarean delivery rates by 15-20% - Improve maternal satisfaction and outcomes - Particularly valuable for Black women (address racial disparities in care) Advantage: Equity-focused models address root causes of maternal mortality disparities; improve outcomes for underserved communities.
Part 7: Regulatory and Policy Tailwinds CMS Telehealth Reimbursement Expansion Expanded telehealth reimbursement for prenatal care (2024-2025) Enables virtual prenatal visits to be reimbursed at specialist rates Removes geographic restrictions on telehealth Accelerates adoption of virtual prenatal care in maternity deserts State Midwifery Licensing 12 states have licensed direct-entry midwives (LDEMs) Additional states considering midwifery licensing Expands access to midwifery-led care in underserved regions Reduces costs while maintaining quality outcomes Maternal Health Funding HHS National Strategy to Improve Maternal Mental Health and Substance Use Care (2024) Increased funding for perinatal mental health services Grants for maternal health innovation Policy tailwind for maternal health platforms Medicaid Expansion Medicaid covers 42% of births in US Medicaid expansion improves access for low-income pregnant women Reimbursement rates increasing in some states Improves economics for maternal health providers
Part 8: Market Opportunity and Investment Implications Market Size Maternity care market: $50B+ annually (prenatal, delivery, postpartum) Maternity care deserts: 43M women; $10B+ opportunity for innovative care models Perinatal mental health: $5B+ market; severely underfunded Maternal health tech: $5B+ market; growing 20-30% annually Thesis 1: Telehealth Fills Maternity Care Deserts - Ro, Nurx, Tia, Maven Clinic, Pomelo Care all expanding prenatal care - Virtual care removes geographic barriers - Enables access in regions lacking OB/GYN services - Regulatory tailwinds (CMS reimbursement expansion) accelerate adoption Thesis 2: Remote Monitoring Enables Distributed Care - Babyscripts, Nirapad enable continuous monitoring without in-person visits - Reduces travel burden on pregnant women - Early detection of complications improves outcomes - Particularly valuable in maternity deserts Thesis 3: Midwifery and CHW Models Improve Access and Equity - Midwifery-led care reduces costs by 20-30% - Community health workers address social determinants - Doulas improve outcomes and reduce disparities - Cost-effective models enable scale in underserved regions Thesis 4: Perinatal Mental Health Is Critical Gap - 1 in 7 women experience postpartum depression - Maternal suicide is leading cause of pregnancy-related death - Perinatal mental health platforms (PSI, Mindstrong, Talkspace, Little Journey) address critical gap - Regulatory and funding tailwinds accelerate adoption Thesis 5: Multiple Business Models Succeed - Telehealth (Ro, Nurx, Tia, Maven Clinic, Pomelo Care) - Remote monitoring (Babyscripts, Nirapad) - Diagnostics (Natera, Illumina) - Mental health (PSI, Mindstrong, Talkspace, Little Journey) - Therapeutics (Comanche Biopharma) - Not winner-take-all; multiple models coexist Thesis 6: Regulatory Tailwinds Accelerate Growth - CMS telehealth reimbursement expansion - State midwifery licensing - HHS maternal health funding - Medicaid expansion - Favorable regulatory environment accelerates adoption
Conclusion Maternity care deserts affect 43M US women; 60% of counties lack obstetric services. Innovative care models—virtual prenatal care, remote monitoring, midwifery-led care, community health worker integration, and perinatal mental health platforms—are filling gaps. Companies addressing maternity deserts span telehealth (Ro, Nurx, Tia, Maven Clinic, Pomelo Care), remote monitoring (Babyscripts, Nirapad), diagnostics (Natera, Illumina), mental health (PSI, Mindstrong, Talkspace, Little Journey), and therapeutics (Comanche Biopharma). Regulatory tailwinds (CMS reimbursement expansion, state midwifery licensing, HHS funding) and market opportunity ($10B+ for innovative models) create favorable conditions for maternal health innovation. Companies building integrated maternal health ecosystems spanning prenatal care, delivery support, postpartum care, and mental health will capture disproportionate value.
Sources & citations →
References ACOG. (2024). "Maternity Care Deserts Report." CDC. (2024). "Maternal Mortality and Morbidity Data." HHS. (2024). "National Strategy to Improve Maternal Mental Health and Substance Use Care." Ro. (2024). "Prenatal Care and Telehealth Expansion." Nurx / Thirty Madison. (2024). "Prenatal Care and Reproductive Health Continuum." Tia. (2024). "Hybrid Virtual + In-Person Women's Health Clinics." Maven Clinic. (2025). "Maternity Care Module and Employer Partnerships." Pomelo Care. (January 2026). "Series C Announcement and Valuation Update." BrightHeart. (2024). "AI-Powered Prenatal Ultrasound and Series A Funding." Babyscripts. (2024). "Remote Fetal Monitoring Platform." Nirapad. (2024). "Remote Maternal Vital Signs Monitoring." Postpartum Support International. (2024). "Perinatal Mental Health Support and Advocacy." Mindstrong. (2024). "Digital Mental Health Platform with Perinatal Focus." Talkspace. (2024). "Telehealth Mental Health and Perinatal Specialists." Little Journey. (2024). "Perinatal Mental Health Platform and Funding." Natera. (2024). "Non-Invasive Prenatal Testing and Diagnostics." Illumina. (2024). "Genomic Sequencing and Prenatal Testing." Comanche Biopharma. (2024). "Preeclampsia Treatment and Series B Funding." CMS. (2024). "Telehealth Reimbursement Expansion for Prenatal Care." ACOG. (2024). "Midwifery Licensing and Access to Care."