The urban-rural maternal healthcare gap has continued to widen in Texas, data shows.
Between 2022 and 2024, the number of “maternal care desert” counties in Texas increased from 126 to 129, according to newly released data from March of Dimes, a maternal health nonprofit.
While a handful of counties climbed from the “low access” to “access” categories, the March of Dimes data shows more than half of Texas counties had no birthing locations and no clinicians who deliver babies.
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Rural patients who can afford the lengthier commutes end up traveling further for prenatal care
“Those that can’t, I fear, go without,” said John Henderson, president of the Texas Organization of Rural & Community Hospitals. “When it’s time to have a baby — and that’s hard to plan — it’s a matter of distance and travel burden.”
Texas’ maternal health reuse of funding challenges. But a more challenging legal landscape for medical providers following the state’s 2022 abortion ban could also be exacerbating rural shortages, experts said.
Read more:
Number of Texas OB-GYNs holding steady in post-Roe environment
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Yearslong funding crisis
Shrinking rural populations across Texas have contributed to funding shortages in rural hospitals — 27 were at risk of closing as of July, according to the Center for Healthcare Quality and Payment Reform.
Because Texas has stringent requirements for Medicaid, many patients don’t have the insurance to afford care, further weakening rural medical facilities’ revenue streams, said Alicia Lee, who leads the March of Dimes Maternal & Child Health Collective Impact site in the Houston area.
That decrease in patient revenue, coupled with the expensive cost of keeping labor and delivery units open, means they can be the first to go when rural hospitals need to save money.
In 2025, Congress appropriated $50 billion to states to fund rural healthcare initiatives through 2030 in the One Big Beautiful Bill Act.
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Critics, however, say that money doesn’t come close to offsetting the bill’s cuts to Medicaid funding. A July 2025 Kaiser Family Foundation analysis of Congressional Budget Office data estimated federal Medicaid spending would decrease by more than $911 billion in the 10 years following the act.
The Texas legislature has also increased Medicaid payments for rural obstetrics funding in the last few terms. Henderson said it’s helped slow, but not stop, the tide of delivery unit closures. To reverse the current trend would require “more significant, targeted investment.”
“If you’re going to deliver babies, you have to be able to do surgery, you have to have anesthesia, you have to have all the equipment,” Henderson said. “It’s probably a multimillion dollar conversation.”
Decrease in specialized support
The U.S. Supreme Court’s 2022 decision to overturn Roe v. Wade, which allowed Texas’ near-total abortion ban to take effect, may have also contributed to a decline in the number of rural OB-GYNs, some doctors said.
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Between 2019 and 2022, the number of counties with no licensed OB-GYNs increased from 152 to 162. Through 2025, it has hovered above 161.
Though family medicine physicians also train in obstetrics and may offer maternal care in some of those counties, the decrease in specialty physicians can still create meaningful disparities in care.
“Even a general obstetrician is taking care of a more complicated patient than family medicine may be comfortable with,” said Dr. Anitra Beasley, a Houston-area OB-GYN and affiliated researcher with Resound Research for Reproductive Health
While some larger hospital systems have invested legal and professional rertion laws, smaller facilities — especially those without specialized OB-GYNs — might not have had the ability to do so.
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That lack of institutional support may have placed additional stress on rural maternal health clinicians, said Dr. Shanna Combs, president of the Texas Association of Obstetricians and Gynecologists
“They’re afraid of the laws too,” she said. “But also, they don’t have an OB-GYN there to back them up. I definitely think it puts (on) a broader strain
Solutions could start with the workforce
In addition to more funding for healthcare facilities, educational institutions could play a more active role in drawing clinicians to rural areas either through residencies and rotations. Broader loan forgiveness programs, supported by The Texas Organization of Rural & Community Hospitals, could help too.
“Physicians tend to stay where they train,” Henderson said. “And if they had more exposure to rural communities, I think some would appreciate the lifestyle.”
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Lee, with March of Dimes, supports making it easier for midwives to prescribe medication and obtain hospital admitting privileges. In areas with less access to physicians or other clinicians, that could still expand patients’ access to care. She also pointed to expanded telehealth options as an example of progress
Ultimately, it’s important to get boots back on the ground in Texas’ rural hospitals, she said.
“You can’t just telehealth your way out of a pregnancy,” Lee said. “You need someone to be able to do the ultrasound. You need a radiologist to read the ultrasound. You want to be able to put hands on an individual to see how she’s progressing in her pregnancy.”
