Birth Without Safety Net
How Medicaid Cuts and Maternal Care Deserts Undermine Family Health
What happens when “choose life” is a mandate, but survival is left to chance?
As Medicaid redeterminations roll out, families already struggling with limited access to care now face heightened uncertainty. Millions of women live in maternal care deserts, where finding an obstetric provider or a safe place to give birth is becoming increasingly complex (March of Dimes, 2024). For many, this means hours-long drives for prenatal care, laboring in ERs unequipped for delivery, or facing childbirth with no medical support at all.
“Choice” now means laboring without care, parenting without coverage, and healing without support. The promise of life is hollow when survival itself is unaffordable.
Medicaid Coverage Losses — The Unwinding Crisis
As pandemic-era continuous enrollment protections end, Medicaid disenrollments are surging, widening coverage gaps at an alarming rate.
Since the unwinding began, nearly 25 million individuals have lost their Medicaid or CHIP coverage nationwide, with 69% of these losses attributed to procedural issues, meaning eligible individuals are being dropped due to paperwork errors (KFF, 2024; CBPP, 2025).
Children account for 43% of those disenrolled, underscoring the growing risk to child health and well-being (KFF, 2024).
Pregnant and postpartum women are among the hardest hit, especially in states that have not implemented the 12-month postpartum coverage extension introduced under the American Rescue Plan Act (ARPA), codified in law in 2021. States that have failed to adopt this extension see significantly higher postpartum coverage losses (KFF, 2024; KFF, 2025).
The overlap between states with high disenrollment rates and those restricting abortion access exposes a contradiction: promoting “pro-life” rhetoric while failing to maintain critical safety net coverage for new families (KFF, 2024).
The result? Families are left navigating uncertainty, instability, and inadequate care during some of the most vulnerable periods of their lives.
While Medicaid disenrollments strip families of essential health coverage, the crisis is compounded by the growing absence of maternal care infrastructure. Even for those who remain insured, geographic and provider shortages turn access into an impossible obstacle, leaving millions stranded in maternity care deserts.
Maternal Care Deserts — Expanding Gaps in Care
Over five million women currently live in a maternity care desert. A maternity care desert is defined as a county where there is no access to hospitals offering obstetric services, birthing centers, or obstetric providers, such as obstetricians, gynecologists, or certified nurse-midwives (Adashi et al., 2025; March of Dimes, 2024).
Recent hospital closures in West Virginia, Kansas, and Georgia have further deepened these care deserts, cutting off access for communities already lacking maternal services (March of Dimes, 2024; Fontenot et al., 2024).
Black women face maternal mortality rates 2.6 times higher than white women (CDC, 2021), while American Indian/Alaska Native (AI/AN) women are 2–3 times more likely to die from pregnancy-related causes (CDC Hear Her, 2024). These rates surpass those of many lower-middle–income countries (CDC, 2021; Shealy et al., 2024).
Latina women also experience elevated risk—25.9 deaths per 100,000 live births, compared with 21.8 among Asian-American women, while Black and AI/AN rates remain highest (Jazmin et al., 2024).
For rural AI/AN communities, the burden is even greater: birthing people living on reservations travel an additional 23.8 miles on average, compared to white women, to reach an OB-equipped facility (Thorsen et al., 2023).
One-third of all U.S. counties are maternity care deserts, and 60% of rural counties fall into this category, with Latina, Black, and AI/AN populations disproportionately affected (March of Dimes, 2024; BMC Preg Childbirth, 2024).
These expanding deserts are not just a loss of services; they represent systemic neglect. Rural communities, as well as Black, Latina, and Indigenous women, face increased risks during pregnancy, insufficient care access, and widening disparities, turning childbirth into a perilous journey rather than a supported life event.
Even beyond medical access, the challenges of pregnancy and postpartum recovery are worsened by the lack of structural support for new families. The absence of national paid leave forces many mothers back to work too soon, deepening health and economic disparities
The U.S. Paid Leave Gap — A System That Fails Families
The United States remains the only high-income country without a national paid maternity leave policy. In contrast, OECD nations provide an average of 18.5 weeks of paid parental leave, ensuring financial stability and postpartum recovery for families (Commonwealth Fund, 2024; OECD, 2023).
With healthcare tied to employment, many mothers, especially those in low-wage jobs, are forced back to work too soon, leading to worse maternal and infant health outcomes (Commonwealth Fund, 2024; OECD, 2023; Baker & Milligan, 2020).
The U.S., one of only six countries globally lacking national paid leave, demonstrates a system that prioritizes profit over family well-being (FindLaw, 2024; Politifact, 2024; Bipartisan Policy Center, 2020).
The inconsistency between state-level programs and the absence of a national standard means millions of workers lack leave coverage, reinforcing economic and health vulnerabilities during critical early life stages. The gap between U.S. policy and global norms reflects a capitalistic system that is incongruent with family health, leaving mothers and babies unsupported during life’s most vulnerable moments.
Despite state-level paid leave programs, the absence of a national standard means millions remain without coverage, deepening economic and health disparities for families already on the brink.
Beyond the absence of paid leave, financial instability and lack of social supports further compound maternal health risks. Food insecurity, another overlooked crisis, forces families to navigate pregnancy and early childhood without reliable access to nutrition, deepening disparities in health outcomes.
Food Insecurity and Maternal Health — A Growing Crisis
In 2023, 13.5% of U.S. households, approximately 47.4 million people, experienced food insecurity, up from 12.8% in 2022 (USDA ERS, 2024; FRAC, 2024).
Since the rollback of pandemic-era benefits and looming SNAP cuts, families have reported higher rates of depression and poorer child health outcomes (FRAC, 2024). Food insecurity during pregnancy is linked to gestational diabetes, preeclampsia, preterm birth, low birth weight, and NICU admissions, conditions that elevate maternal and infant health risks (Carlson & Wimer, 2020; Bell et al., 2024).
Limited access to nutritious food also correlates with postpartum depression and worsened maternal health, while infants born to food-insecure mothers face higher risks of preterm birth, low birth weight, and NICU admission (Bell et al., 2024; Lee et al., 2023).
Food insecurity is not just an economic issue; it is a public health crisis, deepening disparities for vulnerable families and worsening maternal and infant health outcomes.
Infant Risks — Not Just a Maternal Issue
In 2022, the U.S. infant mortality rate rose to 5.61 deaths per 1,000 live births, up from 5.44 in 2021 (CDC National Vital Statistics Reports, 2024). Despite advances in neonatal care, racial and ethnic disparities remain stark:
Infants born to non-Hispanic Black mothers face the highest mortality rate, at 10.90 per 1,000 live births—more than twice the rate of non-Hispanic white infants (4.52) (CDC National Vital Statistics Reports, 2024).
American Indian or Alaska Native infants have a mortality rate of 9.06, while Native Hawaiian/Pacific Islander infants experience 8.50 deaths per 1,000 live births (CDC National Vital Statistics Reports, 2024).
Among Hispanic subgroups, Puerto Rican infants face a higher-than-average risk, with 4.89 deaths per 1,000 live births (CDC, 2023).
Beyond disparities in survival, care deserts continue to limit access to specialized neonatal services like NICUs, leaving families in underserved areas struggling with unaddressed complications from preterm birth and burdensome emergency transfers.
Structural barriers, including poverty, limited prenatal care, and geographic isolation, exacerbate disparities in infant mortality, reinforcing generational cycles of inequity (Rise Health, 2023; CDC National Vital Statistics Reports, 2024).
The consequences extend beyond maternal health. Infants born into healthcare deserts face systemic barriers to survival, underscoring the urgent need for equitable healthcare investments to improve outcomes for the most vulnerable newborns.
Addressing infant mortality requires more than medical interventions; it demands systemic policy changes that remove barriers to care, strengthen financial protections, and ensure families receive continuous support beyond birth.
What Could Help — Toward a Real Pro-Family System
These policy directions are grounded in evidence, with early models showing positive results across different states:
Extend Continuous Postpartum Medicaid
Extending Medicaid coverage through 12–24 months postpartum can reduce gaps in care and improve maternal and infant health outcomes (Raphael & Patel, 2022; Baicker & Finkelstein, 2013).
Target Care Deserts with Workforce Incentives
Targeted funding and incentives, such as loan forgiveness and rural bonuses, can help staff provide essential services in underserved areas, including obstetrics and gynecology (OB/GYN) services, neonatal intensive care units (NICUs), community clinics, and mobile health units (Torbay, 2024).
Expand Medicaid Reimbursement for CHWs and Doulas
Community Health Workers (CHWs): As of early 2022, over half of U.S. states include CHW services under Medicaid plans. Reimbursing CHWs improves care coordination, addresses social determinants of health, and reduces disparities (Milbank, 2023; Health Affairs, 2019).
Doulas:
California’s Medi-Cal reimburses doulas for prenatal, perinatal, and postpartum care—up to 12 months post-birth (MassHealth, 2024; Massachusetts Doula Coalition, 2023).
In 2023, Massachusetts passed legislation (H. 1240/S. 782) to include doula services under Medicaid. More than 15 states plus D.C. now reimburse doulas in some capacity via Medicaid (MassHealth, 2024).
Protect Continuous Medicaid Coverage for Children
Streamlining enrollment and renewal processes can significantly reduce procedural disenrollments and ensure coverage during critical developmental years (Families USA, 2024).
Invest in Upstream Social Supports
Improving access to housing, nutritious food, and early childhood education and care addresses foundational drivers of maternal and infant health disparities (Waldron, 2020; Torbay, 2024).
Implement National Paid Maternity Leave
The U.S. remains the only high-income country without mandated paid parental leave. Aligning U.S. policy with OECD standards would foster recovery, bonding, and improved health outcomes for families (OECD, 2022; Waldron, 2020).
Why These Policies Matter
These policy solutions aren’t theoretical; they have proven success across states. Here’s why they matter:
CHWs and doulas provide culturally competent, community-based care, reducing intervention rates and healthcare costs.
State-level implementation across California, Massachusetts, and New York offers scalable models within Medicaid.
Continuous coverage and social support investments not only enhance health outcomes but also contribute to economic stability and equity.
The success of these policies depends on meaningful action. Without systemic reform, families will continue to bear the consequences of political inaction, widening the gap between rhetoric and reality.
Pro-Family Means More Than Pro-Birth
If we say we value life, how are we building a system that supports it?
Actual pro-family policy must extend beyond birth, ensuring families have the resources to thrive, not just survive. It’s not enough to say “choose life” if, after birth, parents face a lack of healthcare, unsafe neighborhoods, empty pantries, and no paid leave.
We must move beyond rhetoric and demand policies that protect families long after delivery day, recognizing that family well-being hinges on structural supports, not slogans. As The Century Foundation (2025) notes, “Instead of focusing federal policy on procreation, we should be focusing on family-sustaining policies that create meaningful change in people’s lives, no matter what that family looks like.”
Now is the time for lawmakers, advocates, and communities to act. Investing in healthcare access, paid leave, food security, and maternal care is not just a policy choice; it’s a moral imperative. We cannot claim to value life while failing the families who give it.
The system appears to be broken when our higher health spending does not correlate with better outcomes. The United States has the highest rate of maternal death among its economic peer nations, we are better than this, we must be better than this!