The United States is currently confronting a profound maternal health crisis, characterized by alarming rates of preventable pregnancy-related mortality, severe maternal morbidity, and a systemic contraction of perinatal care infrastructure. Nationally, between 650 and 700 women die annually from pregnancy-related complications, while approximately 60,000 others suffer from severe maternal morbidity—defined as unexpected labor and delivery outcomes that carry profound short- or long-term health implications. According to data compiled by the Centers for Disease Control and Prevention (CDC), an astonishing 80 percent of these pregnancy-related deaths, which occur during pregnancy or throughout the postpartum period, are entirely preventable with timely, high-quality medical intervention.
However, delivering timely and effective care has become increasingly difficult as the nation battles a widespread perinatal care access crisis. Between 2010 and 2023, 641 hospital labor and delivery units closed their doors nationwide. These closures have triggered a dangerous cascade of events: patients face widening gaps in the continuity of care, are forced to travel significantly greater distances to reach functioning maternity wards, and consequently experience heightened medical risks for both themselves and their infants. As rural and low-resource communities lose their dedicated obstetric facilities, a growing number of pregnant and postpartum individuals are compelled to seek emergency assistance in non-delivery environments, such as local emergency departments and through emergency medical services (EMS) personnel. Combined with persistent shortages within the perinatal healthcare workforce, these structural failures have severely limited patient choice and dramatically escalated the physical and psychological stress placed upon expectant families.
The Landscape of Colorado’s Maternity Care Deserts
This fragile national health ecosystem is acutely reflected in the state of Colorado, which has found itself navigating an escalating wave of birth facility closures. The consequences of these closures have transformed the state’s healthcare geography: approximately 40 percent of Colorado counties are now officially designated as maternity care deserts, and a staggering 98 percent of all Coloradans reside in areas lacking an adequate supply of prenatal health care providers.
Recognizing the severity of this unfolding crisis, the Colorado Department of Public Health and Environment (CDPHE) commissioned public health research organization JSI in 2025 to conduct a comprehensive study. The investigation focused specifically on examining access to perinatal care across Colorado’s vast rural regions and documenting the direct impacts of rural birth facility closures on patients, local healthcare infrastructure, and emergency responders.
The findings of the CDPHE-commissioned study paint a stark picture of the logistical and clinical hurdles facing rural families. Caitlin Hungate, a Senior Associate at JSI who served as a co-investigator and co-author of the study, detailed the immediate repercussions experienced by study participants.
"Study participants shared that the primary consequence of a birth facility closure was increased travel time to care," Hungate noted. "In rural Colorado, that is often exacerbated by weather, mountain passes, and wildlife on the roads. The increased travel time can be financially and logistically burdensome for women and families, given transportation needs and the implications on childcare and employment leave time."
Beyond the immense logistical strain placed upon expectant parents, the research revealed a troubling systemic shift. When local birthing units close, the immediate burden of managing obstetric emergencies is transferred onto hospital emergency departments and regional emergency medical services. In many cases, these frontline emergency entities are profoundly underprepared to handle acute obstetric events. Emergency medical personnel and emergency room clinicians frequently lack specialized clinical training and hands-on experience in labor and delivery, and they often operate without the appropriate specialized equipment required to safely manage complicated deliveries or neonatal resuscitations.
Chronology of the Perinatal Infrastructure Decline
To understand how Colorado and the broader United States arrived at this juncture, health policy analysts trace a multi-year trajectory of declining rural healthcare viability:
- 2010: The baseline tracking period for national hospital labor and delivery unit closures begins, marking the start of a steady contraction in rural obstetric services driven by financial pressures, declining birth rates in specific regions, and workforce shortages.
- 2010–2023: Across the United States, 641 hospital labor and delivery units shutter permanently, leaving vast swaths of rural America without immediate access to comprehensive maternal care.
- Mid-2010s to 2020: Rural hospitals face compounding economic challenges, including low reimbursement rates for obstetric care, high malpractice insurance premiums for rural family physicians practicing obstetrics, and difficulties in recruiting and retaining specialized nurses and obstetricians.
- 2023–2024: The cumulative effect of closures hits western and rural states heavily, leading to the emergence of widespread "maternity care deserts" where pregnant residents must travel hours to reach the nearest hospital equipped to handle labor and delivery.
- 2025: The Colorado Department of Public Health and Environment (CDPHE) formally engages JSI to execute an in-depth study examining rural perinatal access issues and the downstream effects of facility closures on Colorado’s emergency care network. Following the completion of the study, JSI releases a definitive legislative report outlining actionable recommendations for the state.
Clinical Implications and Systemic Vulnerabilities
The experiences and data gathered during the Colorado study underscore an urgent, undeniable need to fundamentally strengthen healthcare system and workforce readiness for obstetric emergencies. As rural residents find themselves farther from traditional labor and delivery wards, the likelihood of out-of-hospital deliveries, precipitous labors during transit, and complicated emergency room presentations rises significantly.
The JSI study identified several critical, unmet needs across Colorado’s rural health network. Foremost among these is the necessity for ongoing clinical simulation and specialized training programs designed to equip emergency department personnel and EMS workers to respond effectively to high-stakes obstetric emergencies, such as unexpected emergency department births, severe postpartum hemorrhages, or emergency maternal transfers. Furthermore, the report emphasizes the critical requirement for targeted funding to procure new, specialized equipment for non-delivery settings.
Another central finding of the research is the pressing need for enhanced coordination and collaboration between community-based birth providers—such as licensed midwives and doulas—and local emergency medical services. Establishing formal communication channels and streamlined protocols between community birth settings and regional hospitals can drastically improve the safety and efficiency of emergency patient transfers when complications arise outside of a traditional hospital environment.
Legislative Recommendations and the Path Forward
Armed with the empirical findings of the study, JSI authored a comprehensive legislative report designed to provide lawmakers, public health officials, and healthcare administrators with a clear roadmap. The report offers structured recommendations aimed at fortifying Colorado’s perinatal system of care and ensuring that every resident, regardless of geography, retains access to safe, reliable, and high-quality maternal healthcare.
Among the proposed strategies, the report highlights the importance of proactive policymaking to prevent emergency scenarios through better regional resource allocation, supporting telehealth prenatal care integration, expanding mobile health units, and providing financial incentives for rural healthcare providers maintaining obstetric services. By prioritizing these structural interventions, Colorado aims to establish a more resilient health ecosystem capable of withstanding the ongoing pressures of rural facility closures.
Public health advocates emphasize that going forward, Colorado must treat perinatal care access not merely as a localized medical issue, but as a critical public health priority. Preventing obstetric and neonatal emergencies requires deliberate investment in community-level support systems, rigorous training frameworks for non-obstetric providers, and robust logistical safety nets for families living in maternity care deserts.
National Initiatives and Broader Solutions
While state-level interventions are vital, addressing the perinatal care crisis also requires large-scale, coordinated national efforts. Across the United States, maternal health quality improvement initiatives are actively working to bridge the gaps in obstetric emergency care.
A prominent example of this national commitment is the Alliance for Innovation on Maternal Health (AIM). Funded by the Health Resources and Services Administration (HRSA), AIM is a national, cross-sector collaborative dedicated to supporting the implementation of clinical best practices designed to make childbirth safer, improve overall maternal health outcomes, and ultimately save lives.
The AIM Technical Assistance Center, which is managed by JSI, plays a pivotal role in this national mission. By supporting the implementation of evidence-based patient safety bundles across 51 states and jurisdictions—encompassing more than 2,095 birthing facilities, or roughly 74 percent of all birthing facilities in the United States—the AIM TA Center actively works to reduce maternal mortality and severe maternal morbidity nationwide.
Recognizing that the current crisis extends far beyond traditional hospital delivery wards, the AIM TA Center also provides specialized best practices and resource kits tailored for non-obstetric or lower-resource settings. Tools such as the AIM Obstetric Emergency Readiness Resource Kit and the AIM Community Birth Transfer Resource Kit offer invaluable guidance for emergency departments, rural clinics, EMS agencies, and community midwives, ensuring that clinicians everywhere are equipped to manage obstetric emergencies safely and effectively.
As the United States and states like Colorado continue to grapple with the realities of birth facility closures and shrinking healthcare infrastructure, the integration of rigorous research, targeted legislative action, and robust national quality improvement programs offers a vital pathway forward. Through collaborative, cross-sector dedication to workforce readiness and equitable care access, healthcare systems can better protect expectant mothers, mitigate the risks of rural maternity deserts, and ensure that every birth is supported by safe, timely, and high-quality medical care.
