Since UNC Health Chatham’s Maternity Care Center opened in September 2020, it has welcomed 850 new babies. Uniquely, the center employs family physicians rather than only OB-GYNs. This approach addresses the growing shortage of maternity care in rural areas, where many obstetric units have closed.
According to the Cecil G. Sheps Center, over a dozen rural hospitals in North Carolina have shut down since 2005. This has created a gap in accessible maternity care in many counties. Currently, 20 of North Carolina’s 100 counties are labeled as maternity care deserts. This means they lack hospitals and professionals like obstetricians, gynecologists, or certified nurse midwives who can provide adequate support during pregnancy and childbirth.
“We need more hospitals to open their maternity units again, because distance to care matters,” emphasizes Dana Iglesias, a family physician at the center. This urgency is backed by a recent study from March of Dimes published in Jama Network Open, showing babies in counties with poor access to maternity care have a significantly higher risk of dying in their first year.
The 2025 March of Dimes report card rated North Carolina a D+, the same grade as last year and below the national average. The report highlighted alarming statistics: nearly 380,000 U.S. babies were born preterm last year, putting America among the highest rates in developed countries. Furthermore, the state’s infant mortality rate remains concerning, with 834 infants not reaching their first birthday this year.
While some urban areas show improvements, racial and ethnic disparities persist. For example, the infant mortality rate for Black babies stands at 12.1 per 1,000 live births, compared to 5.2 per 1,000 for white babies. Various factors contribute to infant mortality, including preterm births and low birth weight, which together account for over 17% of all infant deaths.
Inadequate prenatal care affects 18.6% of mothers in North Carolina, higher than the national average. Only 72.3% of mothers start prenatal care in the first trimester, which could lead to negative outcomes for both moms and babies.
Despite the grim report, experts like Elizabeth Tilson, the former state health director, see potential for improvement. “These types of metrics take a long time to change,” she says. North Carolina has made strides by expanding Medicaid coverage to mothers for a year after childbirth and allowing certified nurse midwives to practice independently under certain conditions.
Additionally, programs like Nurture NC are focusing on optimizing resources to enhance maternal and infant health. They are working to increase awareness of available services like the NC MATTERS hotline, which offers mental health support for pregnant and postpartum women. Current utilization rates are low, indicating a huge opportunity for improvement.
Some states successfully use mobile care units for prenatal visits, and North Carolina is considering this approach. “This could help with access to care in underserved areas,” notes Pat Campbell from March of Dimes.
Legislative changes are on the horizon as well. A recent bill aimed to license certified professional midwives who can serve in areas with limited access. Increasing the maternal health workforce is crucial to solving these issues.
“It’s going to take investment across multiple sectors for real change,” Tilson explains. The reported statistics reflect an ongoing maternal and infant health crisis that needs urgent attention.
For more details, visit the March of Dimes report card.
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