PURPOSE:
Research confirms that a strong midwifery workforce improves access to essential health services and reduces maternal and infant morbidity and mortality. Significant global efforts have demonstrated that expanding access to midwives through supported education, professional associations, and regulation improves maternal and newborn health outcomes. Yet, in the United States—with the highest maternal mortality rate among high income countries—midwives continue to face restrictive regulations that limit their ability to practice, particularly in rural areas experiencing severe gaps in maternity care.

DISCUSSION:
This presentation will examine the current state of maternal health in the U.S., with a focus on how restrictive state policies prevent midwives from practicing to the full extent of their training. These regulations contribute to poor maternal health outcomes and exacerbate care shortages in rural communities, where hospital closures and the absence of birthing facilities have created widespread maternal care deserts.

EVIDENCE WHERE RELEVANT:
The United States spends more on health care than any other high-income country yet faces the highest maternal mortality rate. According to the 2024 March of Dimes report, 1 in 25 obstetric units in the U.S. has closed within the past two years, with 25% of counties classified as maternity care deserts, lacking a single birthing facility or clinician. In many states, restrictive laws prevent qualified midwives from providing essential care. Additionally, 70% of birth centers are concentrated in just 10 states, leaving millions of women of reproductive age with limited options.

KEY MESSAGE:
Outdated policies restricting midwifery practice are a significant and preventable barrier to addressing the maternal health crisis in rural America. Regulatory reform is essential to expand access to safe, community-based maternal care and close the gap in rural maternal health deserts. Poster session 4 (Group B)