Obstetrics and Maternal-Fetal Medicine: Industry Report on Demand, Workforce and Access

Summary

Obstetrics and Maternal-Fetal Medicine (MFM) connects routine maternity care with specialist care for complex maternal and fetal conditions. Global estimates show a reported fall of about 40 percent in the maternal mortality ratio over the period reported ¹, but progress has slowed to an average decline of about 0.5 percent per year, and more than 100 countries remain short of the global target ². About 94 percent of maternal deaths occur in low-resource settings, and most could have been prevented ³. In the United States, 35 percent of counties are maternity care deserts ⁶, and MFM subspecialists are concentrated in metropolitan areas ¹⁰. Main risks include rural service closures, workforce shortage and the absence of verified market, payer and digital health data. Outlook: access gaps are likely to persist without workforce and rural service action, and stakeholders need primary outcome and cost evidence before judging newer approaches.

Key findings

1. 1

   Most maternal deaths are concentrated and preventable

   About 94 percent of maternal deaths occurred in low-resource settings, and most could have been prevented. Maternal mortality is highest among rural and poorer women.

   Confidence: High
2. 2

   Global progress is slowing

   An estimated 240,000 women died from maternal causes in the latest period. Global declines have averaged about 0.5 percent per year, and more than 100 countries fall short of the global target.

   Confidence: High
3. 3

   Rural maternity care deserts are common and distance is long

   35 percent of US counties are maternity care deserts, and about 6 in 10 of these are rural. Mean travel distance to obstetric care for birthing people in rural deserts is 33.4 miles.

   Confidence: Medium
4. 4

   MFM capacity is concentrated in metropolitan areas

   MFM subspecialists made up 37.7 percent of the OBGYN subspecialty faculty workforce in the study. An older count found 98.2 percent of MFM subspecialists in metropolitan counties with a level III perinatal center.

   Confidence: Medium
5. 5

   Workforce shortage is estimated at a global scale

   A global shortage of 900,000 midwives was cited by a World Bank director in a UN agencies release. This is an estimate, not a counted deficit.

   Confidence: Medium
6. 6

   Rural hospitals are closing labor and delivery units

   Reported reasons include financial losses, staffing shortages and high malpractice insurance costs. This is a qualitative finding from a news report and needs primary confirmation.

   Confidence: Qualitative

1Industry definition and scope

This report treats the industry as obstetric care and maternal-fetal medicine. It covers antenatal, intrapartum and postnatal services, plus the specialist care that manages complex maternal medical conditions and fetal conditions ⁸. General obstetrician-gynecologists and midwives form the base layer, and MFM is the specialist layer within it.

Geographic scope is two-tiered. Maternal mortality indicators are global and come from WHO, IHME and UN agency estimates ¹²⁴⁵. Access, workforce and facility evidence is limited to the United States ⁶⁷⁹¹⁰. The two tiers are not combined into one market figure, and results from one should not be read as applying to the other.

Reporting uses the latest available data. Several US workforce figures come from older studies and are flagged where used. Maternal mortality ratio means maternal deaths per 100,000 live births ¹. A maternity care desert is a county without birthing facilities or providers ⁷. Level of care, as set out in the ACOG and SMFM consensus, ranks facilities by their ability to manage complex conditions ⁸.

Segments covered are service demand, provider types, workforce, technology, regulation and access. Pharmaceuticals, devices and payer economics are excluded because the source pack holds no verified data for them. This is industry analysis, not medical advice for individual patients.

2Market size, structure and value chain

The source pack contains no verified market size or revenue figure for obstetric or MFM services, so this report does not size the market. The evidence instead describes demand, capacity and workforce, which shape how services are organized.

Demand indicators are clearer than market indicators. An estimated 240,000 women died from maternal causes in the latest period, about 5.5 percent of deaths among women aged 10 to 54 ². Sub-Saharan Africa and southern Asia accounted for around 87 percent of estimated global maternal deaths ¹. The pack gives no global birth count for these services, so demand cannot be converted into volume.

In simplified form, the value chain runs from primary and community care for low-risk pregnancy, to hospital labor and delivery units, to higher-level perinatal centers. Higher-level facilities should have MFM consultation available onsite, by phone or by telemedicine ⁸. Most MFM subspecialists resided in metropolitan counties with a level III perinatal center in an older study ¹⁰.

Stakeholders include hospitals and health systems, MFM subspecialists, general obstetricians, midwives, professional bodies, funders and public health agencies. The pack does not verify the public, private and community split of births or MFM services, or revenue models, so stakeholder economics cannot be quantified.

Global maternal mortality estimates differ across sources. The table reports them side by side rather than averaging them.

• Estimated maternal deaths, global 240,000women Observed Global, 204 countries and territories, Latest available data [2]

The three global ratios (197, 191 and 223) come from different sources with different periods and estimation methods. The pack does not explain the method differences, so the spread is reported as a data limitation rather than resolved.

3Customers, demand and adoption

The primary end users are pregnant people, newborns and their families. Demand for specialist input rises when maternal or fetal conditions are complex ⁸. Globally, maternal mortality is highest among rural and poorer communities ³, and US access patterns show a similar rural gradient.

In the United States, 35 percent of counties are maternity care deserts, and about 6 in 10 of these deserts are rural ⁶. More than 2 million women of childbearing age live in counties without birthing facilities or providers ⁷. Mean travel distance to obstetric care is 33.4 miles for birthing people in rural deserts, compared with 17.3 miles for rural counties overall ⁷. The pack holds no waiting-time data for MFM referral or prenatal appointments.

A news report cites 5.8 million women living in maternity care desert counties, drawn from a March of Dimes report ¹¹. Because this figure is secondary, it is shown only to indicate scale and is not used in calculations.

Purchasing criteria, payer preferences and patient satisfaction are not covered by the pack. Barriers identified in a qualitative news report include hospital closures tied to finances, staffing and malpractice costs ¹². Changing expectations, including telehealth uptake, are not verified in primary sources.

• Counties classified as maternity care deserts 35percent of US counties Observed United States, Latest available data [6]

4Competitive landscape and key players

Comparable company-level data is limited. The pack names no maternity hospital operators, device makers or digital health vendors with verified obstetric revenue or outcomes. Provider types are compared instead, and no ranking of quality or cost is made.

Facility tiers are the clearest structural comparison. The ACOG and SMFM consensus places MFM consultation at facilities managing complex conditions and recommends a board-certified MFM subspecialist be available onsite, by phone or by telemedicine at higher-level facilities ⁸. This is professional guidance, and it shapes how facilities position their services.

MFM subspecialists made up 1,757 people, or 37.7 percent of the OBGYN subspecialty faculty workforce, in ACGME-affiliated programs. The study period is not stated in the extract ⁹. An older study counted 1,355 MFM subspecialists, one for every 24 general obstetrician-gynecologists ¹⁰. That count is outdated and cannot show a current trend.

Three provider models are visible. Hospitalist obstetric staffing is described in a news report as reducing maternity care deserts ¹¹, but this is a secondary, qualitative claim. Rural hospitals are closing labor and delivery units ¹². Public, private and community providers cannot be compared on share, quality or cost because the pack holds no verified data for them.

Competitive pressure comes from workforce scarcity. A study projects physician shortages in all but six states over the next decade, especially in rural areas ¹¹. This is a forecast reported secondhand and is treated as an indicative projection, not a settled estimate.

• MFM subspecialists as share of OBGYN subspecialty faculty 37.7percent Observed United States (ACGME-affiliated programs), Study period not stated in source [9]

5Technology, operations and workforce

Verified technology evidence is limited. Telemedicine MFM consultation is recognized as an option at higher-level facilities in the ACOG and SMFM consensus ⁸. The pack holds no verified outcome data for remote MFM consultation or AI fetal monitoring, so those approaches are treated here as emerging and unverified, not established practice.

A global shortage of 900,000 midwives was cited by a World Bank director in a UN agencies release ⁴. This is an estimate. Within the US MFM subspecialty faculty, the workforce is primarily female, mid-career and holds allopathic degrees ⁹. These facts describe the workforce profile but do not give a supply forecast.

Operational pressure is visible in closures. Rural hospitals cite financial losses, staffing shortages and malpractice insurance costs when they close labor and delivery units ¹². Since most maternal deaths could have been prevented ³, timely access to staffed care is a central operational issue, although the pack does not quantify this link.

Burnout prevalence among OB/GYNs is not verified from a primary ACOG source. A vendor article figure of about 40 percent is excluded. Productivity measures for hospitalist models are not available in the pack.

6Regulation, standards, risk and sustainability

Jurisdiction for the standards cited here is the United States. The ACOG and SMFM Obstetric Care Consensus is professional guidance, not statute or regulation ⁸. The pack does not identify binding federal or state requirements for obstetric staffing or facility licensure, so binding rules cannot be stated from the evidence.

Globally, the SDG 3.1 target calls for a maternal mortality ratio below 70 per 100,000 live births. It is a development target, not a binding legal obligation in the pack, and the world is not on track to meet it ⁵.

Liability costs are a cited risk. High malpractice insurance costs are one reason given for labor and delivery closures ¹², a qualitative news claim. The pack has no verified data on malpractice premiums or the legal frameworks that drive them.

Equity and safety are central. Mortality is highest among rural and poorer women ³, and in nine humanitarian-crisis countries the maternal mortality rate was 551 per 100,000 live births, more than double the world average ⁴. Privacy, data protection and environmental or sustainability factors are not addressed by the pack, so they are not assessed. This section is not medical or legal advice, and clinical decisions depend on individual assessment.

7Challenges, opportunities and case examples

The main constraints are slow global progress, with declines averaging about 0.5 percent per year ², rural access distance ⁷, workforce scarcity ⁴¹¹ and facility closures ¹². Affordability and payment pressure cannot be assessed because the pack holds no verified cost or reimbursement data.

Opportunities include hospitalist staffing models that may extend obstetric coverage ¹¹, and telemedicine MFM consultation where onsite specialists are scarce ⁸. Both are plausible routes to access but need primary outcome and cost evidence before they can be judged.

Case example one: nine humanitarian-crisis countries show a maternal mortality rate of 551 per 100,000 live births against a world average of 223 ⁴. This illustrates the burden concentrated in crisis settings. It is an aggregate, not a provider case.

Case example two: rural US hospitals closing labor and delivery units, cited for financial losses, staffing and malpractice costs ¹². Case example three: obstetric hospitalist staffing, described as reducing maternity care deserts ¹¹. The pack gives no before-and-after measurements for this model.

Comparable named provider examples were limited. The pack names no individual hospital system with verified performance data.

8Outlook and strategic implications

In the near term, the most likely path is continued but slow improvement in global maternal mortality, with reported ratios ranging from 191 to 223 depending on the source ¹²⁵. Progress is unlikely to close the gap to the SDG target without faster declines in the highest-burden settings ²⁵.

In the medium term, the main US risk is persistent rural access gaps. A projected physician shortage in all but six states would reinforce the concentration of MFM care in metropolitan areas ¹⁰¹¹. This projection is secondary and should be treated as indicative.

Implications differ by stakeholder. Hospitals and health systems should assess level-of-care capacity and referral pathways ⁸. Policymakers should prioritize rural access and staffing. Workforce planners need current MFM counts, which the pack does not provide. Digital health developers need primary outcome and cost evidence before claiming benefit.

Remaining uncertainties include the MFM workforce count, payer economics, digital adoption and outcomes of experimental approaches. Each should be verified before major investment decisions.

Scenarios are interpretive. They use only pack figures and flag forecast and secondary inputs.

9Conclusion

Maternal mortality remains concentrated in low-resource settings and among rural and poorer women ³. In the United States, travel distance and workforce concentration define access to MFM care ⁷¹⁰. Verified market, payer and digital health data are missing, so the most defensible takeaways concern demand, workforce and access.

How this was built

Sources

1. 1

   Maternal mortality

   World Health Organization Official statistics

   who.int
2. 2

   Global maternal deaths fell to 240,000 in the latest period, but more than 100 countries still fall short of the global maternal mortality target as progress slows worldwide

   Institute for Health Metrics and Evaluation (University of Washington) Peer-reviewed

   healthdata.org
3. 3

   Maternal Health

   Pan American Health Organization (PAHO/WHO) Official statistics

   paho.org
4. 4

   Trends in maternal mortality (UN agencies joint release)

   WHO, UNICEF, UNFPA, World Bank Group and UNDESA Population Division (as reported by PMC repository) Official statistics

   ncbi.nlm.nih.gov
5. 5

   Global and regional causes of maternal deaths: a WHO systematic analysis

   WHO systematic analysis, The Lancet Global Health Peer-reviewed

   thelancet.com
6. 6

   Maternity care deserts across the US (latest March of Dimes report) and related March of Dimes findings

   March of Dimes Industry association

   marchofdimes.org
7. 7

   Navigating geographical disparities: access to obstetric hospitals in maternity care deserts and across the United States

   BMC Pregnancy and Childbirth (peer-reviewed study) Peer-reviewed

   ncbi.nlm.nih.gov
8. 8

   ACOG/SMFM Obstetric Care Consensus: levels of maternal care

   ACOG and SMFM (Obstetric Care Consensus) Standard

   nciom.org
9. 9

   Subspecialty Faculty in Obstetrics and Gynecology: Distribution, Demographics, and Implications for Training and Clinical Practice

   PMC peer-reviewed study (ACGME-affiliated residency programs) Peer-reviewed

   pmc.ncbi.nlm.nih.gov
10. 10

    Maternal-Fetal Medicine Workforce in the United States

    American Journal of Perinatology (Thieme) observational study of ACOG roster Peer-reviewed

    thieme-connect.de
11. 11

    Rise of Ob Hospitalists Reduces Maternal Health Deserts

    Medscape (news report) News report

    medscape.com
12. 12

    Maternity deserts aren't accidents. They're the result of a design flaw

    STAT News (news report) News report

    statnews.com