The United States is currently grappling with a profound maternal health crisis, characterized by alarming rates of preventable mortality and severe morbidity alongside a rapidly deteriorating 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 carrying serious short- or long-term health ramifications. According to data compiled by the Centers for Disease Control and Prevention (CDC), more than 80 percent of these pregnancy-related deaths are entirely preventable when timely, high-quality medical intervention is available. Yet, this safety net is fraying at an unprecedented pace, particularly in rural and economically disadvantaged regions where access to labor and delivery services has diminished drastically over the past decade and a half.
This national crisis is acutely mirrored in the state of Colorado, where a wave of rural hospital closures has left a staggering 40 percent of the state’s counties designated as maternity care deserts. Compounding this issue, a recent assessment indicates that 98 percent of all Coloradans now reside in areas with an inadequate supply of prenatal health care. Recognizing the immediate dangers posed by these systemic gaps, the Colorado Department of Public Health and Environment (CDPHE) commissioned public health research organization JSI in 2025 to conduct a comprehensive study examining perinatal care access in rural regions and evaluating the direct impacts of shuttered birth facilities. The resulting findings, recently published in a detailed legislative report, outline a grim reality for rural families and offer critical policy recommendations to safeguard maternal and infant health across the state.
The Anatomy of a National Perinatal Care Access Crisis
The erosion of maternal health infrastructure in the United States is primarily driven by widespread closures of hospital-based labor and delivery units. National statistics paint a concerning picture of steady institutional withdrawal from maternity care: between 2010 and 2023, a total of 641 hospital labor and delivery units closed nationwide. These closures are rarely isolated incidents; rather, they reflect a broader macroeconomic and systemic strain on rural hospitals facing soaring operational costs, declining birth rates, workforce shortages, and inadequate insurance reimbursement rates for obstetric services.
When a local labor and delivery unit shuts its doors, the immediate consequence is a sudden and dangerous disruption in the continuum of care. Patients who previously relied on nearby community hospitals are suddenly forced to travel significantly greater distances to reach the nearest functioning facility. This geographic displacement introduces severe risks during both routine prenatal care and emergency obstetric events. Furthermore, as delivery units disappear from rural and low-resource landscapes, pregnant and postpartum individuals are increasingly forced to seek emergency obstetric care in non-traditional settings, such as hospital emergency departments (EDs) or through emergency medical services (EMS) personnel who may lack specialized training in childbirth complications.
The cumulative effect of these closures extends far beyond physical geography, fostering pervasive uncertainty and psychological distress among expectant parents. Reduced facility availability limits patient choice, forcing individuals to navigate complex logistical hurdles during one of the most vulnerable periods of their lives. For rural communities, the loss of a local maternity ward acts as a catalyst for broader economic and social decline, discouraging young families from settling in regions that lack basic healthcare infrastructure.
Colorado’s Fragile Health Ecosystem: A Case Study in Maternity Deserts
Colorado’s healthcare landscape serves as an instructive and sobering case study of the vulnerabilities facing the broader American health ecosystem. Despite its reputation for overall health and active lifestyles, the state struggles with deep geographic disparities in healthcare access. Mountainous terrain, vast rural expanses, and extreme weather patterns uniquely complicate the delivery of medical services in Colorado.
By 2025, the compounding effect of rural hospital contractions resulted in four out of ten Colorado counties being officially classified as maternity care deserts. Even more alarming is the finding that 98 percent of the state’s population now lives in regions experiencing an inadequate supply of prenatal health care providers. This widespread deficiency places an extraordinary burden on regional medical centers that remain operational, stretching their resources thin and forcing healthcare providers to absorb overflow from vast geographic catchments.
In response to these mounting pressures, the CDPHE partnered with JSI to investigate how rural communities are adapting to the loss of local birth facilities and to measure the precise toll these closures are exacting on patients and local emergency infrastructure.
Insights from the Field: The JSI Rural Perinatal Study
The 2025 JSI study on perinatal care access utilized qualitative and quantitative methodologies, engaging healthcare providers, emergency responders, community leaders, and patients across rural Colorado to understand the lived experiences of those navigating maternity care deserts. The findings underscore the multi-layered hardships imposed by facility closures.
Caitlin Hungate, Senior Associate at JSI and co-investigator and co-author of the study, highlighted the primary logistical barrier identified by participants. "Study participants shared that the primary consequence of a birth facility closure was increased travel time to care," Hungate stated. "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 sheer physical distance and treacherous travel conditions, the study revealed a critical systemic shift: the burden of managing obstetric emergencies is increasingly falling on hospital emergency departments and emergency medical services that are ill-equipped for the task. Unlike dedicated labor and delivery wards staffed by specialized obstetric nurses, neonatologists, and OB-GYNs, rural EDs and local EMS teams frequently lack the specific clinical training, hands-on experience, and specialized equipment required to manage complex labor and delivery complications, postpartum hemorrhage, or neonatal resuscitation.
Consequently, patients experiencing rapid or unexpected labor outside of a hospital setting often arrive at facilities where staff must improvise life-saving care under high-stress conditions. This mismatch between community needs and institutional readiness significantly elevates the risk of adverse maternal and neonatal outcomes.
Strategic Recommendations for Systemic Resilience
The alarming insights generated by the JSI study highlight an urgent imperative: state and local health systems must systematically reinforce workforce readiness and infrastructure to manage obstetric emergencies in non-traditional settings. The legislative report authored by JSI following the study outlines a series of targeted, actionable recommendations designed to fortify Colorado’s perinatal system of care and ensure equitable access to safe, reliable, and high-quality medical services.
Among the core recommendations are initiatives to implement ongoing simulation training and specialized clinical education for emergency department staff and EMS personnel. Equipping these first-line responders with the skills to confidently handle emergency deliveries, precipitous births, and urgent patient transfers can mean the difference between life and death. Additionally, the report emphasizes the critical need for dedicated funding streams to procure modern specialized equipment for rural emergency departments.
Another major focus of the legislative recommendations is fostering closer coordination and collaboration between formal medical institutions and community birth providers, such as licensed midwives and doulas. Establishing streamlined, formalized communication channels between community birth settings and local emergency medical services can significantly optimize the safety and efficiency of emergency patient transfers, ensuring a seamless continuum of care when complications arise outside of a hospital.
By adopting these strategic measures, Colorado aims to establish a proactive framework that prevents and prepares for obstetric and neonatal emergencies, thereby mitigating the hazards associated with ongoing birth facility closures.
National Initiatives and the Role of the Alliance for Innovation on Maternal Health (AIM)
While state-level interventions in Colorado provide a crucial blueprint for regional reform, addressing the broader American maternal health crisis requires robust national coordination and standardized quality improvement frameworks. A cornerstone of this national effort is the Alliance for Innovation on Maternal Health (AIM).
AIM is a national, cross-sector commitment funded by the Health Resources and Services Administration (HRSA) designed to support the implementation of patient safety bundles—coordinated sets of evidence-based clinical practices—that make childbirth safer, improve health outcomes, and ultimately save lives. The AIM Technical Assistance Center, which is managed by JSI, plays a pivotal role in translating these evidence-based protocols into clinical practice across the country.
Currently, the AIM TA Center supports the implementation of safety bundles in 51 states and jurisdictions, reaching more than 2,095 birthing facilities nationwide, which accounts for approximately 74 percent of all birthing facilities in the United States. Through rigorous technical assistance, data collection, and dissemination of best practices, AIM helps hospitals institutionalize standardized responses to leading causes of maternal mortality, such as severe hypertension, obstetric hemorrhage, and venous thromboembolism.
Recognizing the specific vulnerabilities highlighted by rural closures and out-of-hospital deliveries, the AIM TA Center has also developed specialized resources 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 provide essential guidance for emergency departments, urgent care centers, and community birth attendants. These resources offer practical protocols for recognizing obstetric emergencies, stabilizing patients, and executing safe, timely inter-facility transfers, bridging the gap between community-based care and advanced hospital interventions.
Fact-Based Analysis of Implications and Future Outlook
The intersection of nationwide hospital closures, rural maternity care deserts, and persistent racial and socioeconomic disparities in maternal health presents a formidable challenge to the United States healthcare system. The financial pressures forcing rural hospitals to shutter their labor and delivery units show little sign of abating spontaneously, suggesting that the trend of declining access may continue in the near term unless targeted legislative and financial interventions are enacted.
The implications of this trend extend far beyond individual medical tragedies. From an economic perspective, the loss of local maternity care increases out-of-pocket travel and lodging costs for rural families, forces lost wages due to extended travel and recovery times, and places a heavy financial toll on emergency transport networks. From a public health standpoint, shifting obstetric care to underprepared emergency departments increases the likelihood of medical errors, delayed interventions, and psychological trauma for patients.
However, the growing recognition of these systemic failures has sparked a concerted policy and operational response. Reports like the one commissioned by the CDPHE and authored by JSI serve as vital catalysts for legislative action, providing lawmakers and health officials with empirical data and expert recommendations to guide resource allocation. By investing in rural workforce training, expanding telehealth capabilities for prenatal monitoring, funding emergency equipment grants, and integrating community birth providers into the broader emergency response network, states can construct a more resilient safety net.
Ultimately, addressing the perinatal care crisis requires a paradigm shift that views maternal health infrastructure not merely as a component of hospital profitability, but as an essential public utility critical to the stability and well-being of society. Through coordinated state-level strategies—such as those advancing in Colorado—and comprehensive national frameworks like the Alliance for Innovation on Maternal Health, the public health community is striving to reverse the tide of maternal mortality, ensuring that every pregnant and postpartum individual has access to the timely, high-quality care they deserve, regardless of geography.
