North Dakota Ranks Worst in the Nation for Maternity Care Deserts as 71.7% of Its Counties Offer No Obstetric Care

A new study from Birth Injury Lawyers Group finds that a woman’s home state has become one of the clearest predictors of whether she can reach a hospital, birth center, or obstetric provider during pregnancy. Just over 35% of U.S. counties now qualify as maternity care deserts, which March of Dimes defines as counties with no hospital or birth center providing obstetric care and no practicing obstetric provider, including physicians, certified nurse midwives, and nurse practitioners. Roughly 2.3 million women of reproductive age live in these counties, and another 3.3 million live in counties with severely limited access. Together that is 5.6 million women preparing for childbirth without reliable local care, and about 150,000 babies are born in maternity care deserts every year.

North Dakota ranks worst by a wide margin. 71.7% of its counties offer no maternity care, and 43.8% of the state’s women of childbearing age (about 69,900 women) live more than 30 minutes from a birthing hospital. South Dakota ranks second, with 56.1% of its counties classified as deserts and 23.7% of its women of childbearing age (about 40,700) facing long travel times. Oklahoma follows with 53.2% of counties lacking maternity care and 12.8% of its women (about 105,200) living more than 30 minutes from a facility. Nebraska and Mississippi round out the five worst states.

The study shows that the share of counties without care and the share of women facing long drives can tell very different stories. Alaska and Montana each have half of their counties classified as deserts, yet only 7.8% of Alaskan women (about 11,500) live more than 30 minutes from a birthing hospital, compared with 18.4% in Montana (about 39,200). In West Virginia, 49.1% of counties are deserts and 22.2% of women (about 69,600) face extended travel. Nevada’s desert rate is 47.1%, and while only 10% of its women of childbearing age face travel limitations, its larger population means that still amounts to about 64,600 women. Kentucky stands out most of all. Although 45.8% of its counties are deserts, 31.3% of its 878,135 women of childbearing age live more than 30 minutes from a birthing hospital. That is the worst distance rate outside North Dakota and works out to roughly 275,000 women, the largest raw total of any state.

At the other end of the rankings, New York has the lowest maternity desert rate in the country at 3.2%, followed by Maryland (4.2%), New Jersey (4.8%), Arizona (6.7%), and California (6.9%). Vermont (7.1%), Pennsylvania (7.5%), Oregon (8.3%), South Carolina (13%), and Ohio (14.8%) complete the ten best-performing states. Vermont shows why county rates alone can mislead. Only 7.1% of its counties qualify as deserts, but 29.4% of its women still live more than 30 minutes from a birthing hospital. The gap between New York’s 3.2% and North Dakota’s 71.7% is roughly 22-fold. Connecticut, Delaware, Hawaii, Maine, Massachusetts, New Hampshire, and Rhode Island use a different county access framework and were excluded for comparability, though their reported figures suggest they would rank among the stronger performers.

The burden also falls unevenly by race. American Indian and Alaska Native (AIAN) women account for about 1% of births nationally, yet they represent 17% of births in Alaska, 12% in South Dakota, 8% in Oklahoma and Montana, and 6% in North Dakota, all states with some of the highest desert rates. In Alaska, 8% of babies born to Alaska Native women were born in a maternity care desert. In Mississippi, Black births make up 38% of all births, more than five times the average share across the ten worst desert states, and the state pairs a 51.2% county desert rate with a 15% preterm birth rate, the highest in the analysis. In North Dakota, 16.5% of BIPOC women in high vulnerability areas received inadequate prenatal care, more than four times the rate in low vulnerability areas.

The health consequences are measurable. Women giving birth in maternity care deserts face a 13% higher risk of preterm birth, a 1.3 times higher rate of pre-pregnancy hypertension, and up to a 2.5 times higher risk of an unplanned out-of-hospital birth when travel times are especially long. Since the last official count, more than 100 additional counties have lost maternity care access, and each closure pushes displaced patients onto nearby providers that may already be stretched thin.