Maine’s Rural Maternity Crisis: A Policy Agenda

Abstract

Maine faces a worsening rural maternity crisis driven by the closure of hospital maternity units and deteriorating maternal health. Fifty-two percent of Maine's rural hospitals have closed their maternity units, creating vast maternity care deserts where pregnant women face the longest average drive times in New England for prenatal care and delivery. This crisis is compounded by workforce shortages, hospital financial pressures, declining birth rates, and Maine's status as the nation's oldest and most rural state. Rural pregnant women experience disproportionately high rates of chronic disease, substance use disorders, and mental health conditions, contributing to worse maternal and infant outcomes. Evidence-informed policy solutions require concurrent action: ensuring rural hospital financial stability through alternative reimbursement models, implementing regional care coordination, expanding telehealth services, diversifying the maternity workforce, addressing public health challenges and social determinants, ensuring safety across all birth settings, and supporting rural immigration to sustain communities and healthcare systems.