Nearly Half of US Counties Lack an OB/GYN
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- Nearly half of U.S. counties lack a practicing OB/GYN as rural hospitals steadily close labor and delivery units, citing financial losses, staffing shortages, and high malpractice insurance costs.
- South Dakota has one of the highest fertility rates in the nation but no obstetrics and gynecology residency program, leaving more than half its counties classified as maternity care deserts by the March of Dimes.
- The U.S. fertility rate has fallen 23% over two decades, yet maternity care access is shrinking in rural America rather than easing with lower demand.
- Medicare funds most U.S. residency positions, but the slots concentrate in urban academic medical centers — and the Association of American Medical Colleges warns this structure drives workforce shortages in underserved areas.
- Rural women, particularly low-income, Black, and Indigenous patients, face higher maternal morbidity and mortality per the CDC, with delayed care and longer travel times worsening outcomes.
- Authors Jocelyn Mitchell-Williams and Vijay Rajput propose tying federal residency funding to shortage areas, building regional distributed training models across state lines, and capping malpractice damages — noting some states already cap pain-and-suffering awards at $250,000.
Why it matters: The piece reframes a worsening maternal health crisis — disproportionately killing Black, Indigenous, and low-income rural women per CDC data — as a fixable structural problem. With nearly half of U.S. counties lacking an OB/GYN and South Dakota showing no residency pipeline despite high fertility, the bottleneck isn't physician supply but where Medicare-funded training slots are placed.
