Rural Texas Maternal Health Assembly
Working together to strengthen maternal health care and build a stronger future for rural Texas.
The Rural Texas Maternal Health Assembly brings together leaders from across rural health care and beyond to identify practical, consensus-driven opportunities to strengthen maternal health services, workforce, infrastructure, and outcomes across rural Texas.
Read the Updated 2026 Rural Texas Maternal Health Rescue PlanThe Problem
Rural communities are an important part of Texas’ economy, culture, and way of life. Strong maternal health systems are essential to ensuring rural communities remain places where women and families can live, work, and thrive.
Yet Access to maternal and primary care remains a significant challenge across rural Texas.
- 60% of rural Texas counties are maternal care deserts, affecting nearly 272,000 women and 18,000 births each year.
- 65% of rural hospitals no longer provide maternity care.
- 58% of rural counties lack sufficient primary care, with one in five having no primary care physician.
- 23.8% of rural women lack health insurance.
These challenges require a coordinated, cross-sector response.
Source: March of Dimes
The Process
From Rescue to Moonshot
In 2024, the Rural Maternal Health Assembly brought together more than 40 organizations representing rural clinicians, hospitals, community health centers, academic institutions, consumer advocates, foundations and other partners.
Together, Assembly members examined dozens of potential initiatives and identified 12 shared priorities for state policymakers and regulators. The result was the Rural Texas Maternal Health Rescue Plan, a consensus-driven framework focused on stabilizing services, strengthening the rural workforce, and preserving access to essential care.
Following the 89th Texas Legislature, the Assembly reconvened in 2026 to assess progress and consider what comes next.
The second edition of the Rescue Plan documents progress across several of the original Code Red priorities, including rural hospital payment, maternal health workforce funding, and state investment in women’s health programs.
The work is now expanding beyond immediate stabilization toward a coordinated, longer-term strategy for rural maternal health.
A Healthy Rural Texas Pregnancy Moonshot
The Assembly’s 2026 vision is a coordinated, multi-year effort spanning the full maternal health continuum, from preconception and preventive care through pregnancy, birth, postpartum, and the period between pregnancies.
The goal is to build on progress already underway while strengthening the systems, services, workforce, and partnerships rural communities need to support women and families throughout that continuum.
Co-Conveners
With special appreciation to Helen Kent Davis, Principal, HKD Associations, RMHA Senior Policy Advisor. The Assembly’s work is informed by perspectives from across rural health care and beyond, including clinicians, hospitals, community health centers, academic institutions, consumer advocates, foundations, and other partners. With generous support from the T.L.L Temple Foundation.
Timeline
More than 40 organizations came together to develop a shared agenda for rural maternal health.
2025 – First Rescue Plan
The Assembly released its first Rescue Plan, outlining 12 priorities organized by urgency.
2026-26 – Progress
The Assembly assessed progress following the 89th Texas Legislature, including developments related to rural hospital stability, workforce, women’s health, and maternal health capacity.
2026 – Assembly reconvenes
The original conveners, joined by the Texas Association of Community Health Centers, reconvened the Assembly to consider the next phase of the work.
2026 – From Rescue to Moonshot
The second edition builds on the original agenda, documents progress, and outlines opportunities for a coordinated, longer-term strategy for rural maternal health.
Contact
The Rural Texas Maternal Health Assembly is an ongoing effort to bring people and organizations together around the future of maternal health in rural Texas.
As the work moves from rescue toward a longer-term vision, the Assembly will continue to examine what is working, where gaps remain, and where collaboration can strengthen maternal health systems across rural communities.
For additional information, Please contact:
Helen Kent Davis, Senior Advisor
Texas Academy of Family Physicians
Texas Health Institute
Consultant
helen@hkdhealthpolicy.com
Explore the Plans
2026 Moonshot Plan Executive Summary
A concise overview of the challenges, progress, priorities, and vision outlined in the second edition. [Read the 2026 Executive Summary]
From Rescue to Moonshot: 2026 Plan
The second edition documents progress across the Assembly’s original priorities and outlines a longer-term vision for strengthening rural maternal health. [Read the Entire 2026 Plan]
2025 Rural Texas Maternal Health Rescue Plan
Explore the original framework and 12 priorities that established the foundation for the Assembly’s work. [Read the 2025 Plan]
Rural Maternal Health Resources
Background Materials/Data Resources
Texas Health Data - Maternal Health2022-MMMRC-DSHS-Joint-Biennial-Report.pdf (texas.gov)
Maternal Health: Availability of Hospital-Based Obstetric Care in Rural Areas | U.S. GAO
TCHMB
2024 State Scorecard on Women’s Health and Reproductive Care | Commonwealth Fund
State Policy Lever Checklists - Prenatal-to-3 Policy Impact Center (pn3policy.org)
A Worsening Crisis: Obstetric Care in Rural America (harvard.edu)
U.S. maternal health: State shares of rural hospitals without maternity care (axios.com)
HRSA Invests Nearly $90 Million to Address Maternal Health Crisis | HRSA
Creating Health Care Models to Improve Maternal Health | MCHB (hrsa.gov) (Bexar county hospital district received funding)
Task Force on Maternal Mental Health National Strategy to Improve Maternal Mental Health Care (samhsa.gov)
Maternity Care Access
Can Family Doctors Deliver Rural America From Its Maternal Health Crisis? - KFF Health News
Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity | March of Dimes
Maternal Health in Rural Communities
Rural Obstetric Unit Closures - The University of Minnesota Rural Health Research Center (umn.edu)
Restoring Access to Maternity Care in Rural America | Commonwealth Fund
Postpartum Morbidity and Mortality and Health Care Utilization in Rural vs. Urban Communities - The University of Minnesota Rural Health Research Center (umn.edu)
Microsoft PowerPoint - Hospital Webinar FINAL (nationalacademies.org)
Rural resilience: The role of birth centers in the United States - Jolles - 2020 - Birth - Wiley Online Library
Promoting Safety in Community-Based Birth Settings | AAFP
Assessment of interprofessional collaboration at free-standing birth centers: Does collaboration influence outcomes? - ScienceDirect
Postpartum Newborn Home Visits | SCDHEC
Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them | KFF
Innovation
HRSA Administrator Carole Johnson, Joined by Rep. Lauren Underwood, Launches New National Maternal Health Initiative | HRSARural Maternal Health Toolkit - RHIhub (ruralhealthinfo.org)
HRSA Rural Maternal Health Initiatives - RHIhub Webinar (ruralhealthinfo.org)
Rural Maternal Health – Models and Innovations - Rural Health Information Hub
Expanding Telehealth for Improved Maternal Outcomes - Maternal Health Learning and Innovation Center
Maternal Opioid Misuse (MOM) Model | CMS
rural-case-study-meeting-essential-health-services-and-reimagining-obstetrics-in-a-rural-community-rural-case-study-april-2024.pdf (aha.org)
Postpartum Primary Care Engagement Using Default Scheduling and Tailored Messaging: A Randomized Clinical Trial | Public Health | JAMA Network Open | JAMA Network
Maternity Care Payment Reform | National Partnership for Women & Families
Blueprint for Advancing High-Value Maternity Care Through Physiologic Childbearing | National Partnership for Women & Families
Postpartum Discharge Transition Staging | AIM (saferbirth.org)
Community-Based Models Improve Maternal Outcomes and Equity | Commonwealth Fund
Navigating geographical disparities: access to obstetric hospitals in maternity care deserts and across the United States | BMC Pregnancy and Childbirth | Full Text (biomedcentral.com)
Improving access to maternal care in rural communities | AHA News
Mapped: Over half of rural hospitals don't offer maternity care (advisory.com)
Proposed Solutions for Improving Maternal Health Care in Rural America - PubMed (nih.gov)
The Role of the Family Physician in Rural Maternity Care
CNM/CMs Fill the Gap in Rural Maternal Care
The Need for Reliable Robust Maternal Transport Program to Improve Maternal Outcomes in Rural America
Text And Telephone Screening And Referral Improved Detection And Treatment Of Maternal Mental Health Conditions | Health Affairs
Mental Health Conditions Increase Severe Maternal Morbidity By 50 Percent And Cost $102 Million Yearly In The United States | Health Affairs
Centering Healthcare Institute | CenteringPregnancy
Medicaid-Payment-Initiatives-to-Improve-Maternal-and-Birth-Outcomes.pdf (macpac.gov)
Chapter 4: Maternity Care (hcp-lan.org)
Preventive/Primary Care
Access to and Use of Midwifery Care for Rural Residents - The University of Minnesota Rural Health Research Center (umn.edu)New Recommendations for Number of Required Prenatal Visits - The ObG Project
A Toolkit for Implementing Two-Generation Postpartum Care - I PROMOTE-IL (ipromoteil.org)
UMN-Case-Series_Postpartum-Support_8.4-final.pdf
MiPath Infographic for Providers (acog.org)
Telemedicine in Low-Risk Obstetrics - ScienceDirect
Obstetrics & Gynecology (lww.com)
Postpartum care needs assessment: women’s understanding of postpartum care, practices, barriers, and educational needs | BMC Pregnancy and Childbirth | Full Text (biomedcentral.com)
Provider Perspectives on Barriers and Facilitators to Postpartum Care for Low-Income Individuals - PMC (nih.gov)
NMDOH
Food Insecurity, Chronic Disease, and Health Among Working-Age Adults (usda.gov)Getting around rural America without a car is hard. These communities developed solutions | KCUR - Kansas City news and NPR
Rural Hunger and Access to Healthy Food Overview - Rural Health Information Hub
Food Insecurity in the Rural United States: An Examination of Struggles and Coping Mechanisms to Feed a Family among Households with a Low-Income - PMC (nih.gov)
Systematic Review of Interventions Addressing Food Insecurity in Pregnant Women and New Mothers - PMC (nih.gov)
Food Insecurity and Cardiovascular Health in Pregnant Women: Results From the Food for Families Program, Chelsea, Massachusetts, 2013–2015 (cdc.gov)
Pregnant and hungry: addressing food insecurity in pregnant women during the COVID-19 pandemic in the United States - PMC (nih.gov)
Food insecurity among pregnant women living in high-income countries: a systematic review - The Lancet
Relevant Peer-Reviewed Papers Published since 2020
Ahn, R., Gonzalez, G. P., Anderson, B., Vladutiu, C. J., Fowler, E. R., & Manning, L. (2020). Initiatives to reduce maternal mortality and severe maternal morbidity in the United States: A narrative review. Annals of Internal Medicine, 173(11_Supplement), S3-S10. https://www.acpjournals.org/doi/full/10.7326/M19-3258Singh, G. K. (2021). Trends and social inequalities in maternal mortality in the United States, 1969-2018. International Journal of Maternal and Child Health and AIDS, 10(1), 29. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792749/
Chinn, J. J., Eisenberg, E., Dickerson, S. A., King, R. B., Chakhtoura, N., Lim, I. A. L., ... & Bianchi, D. W. (2020). Maternal mortality in the United States: research gaps, opportunities, and priorities. American journal of obstetrics and gynecology, 223(4), 486-492. https://www.sciencedirect.com/science/article/abs/pii/S0002937820307420
Ziller, E., & Milkowski, C. (2020). A century later: Rural public health’s enduring challenges and opportunities. American journal of public health, 110(11), 1678-1686. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2020.305868
Kozhimannil, K. B., Interrante, J. D., Tuttle, M. K., & Henning-Smith, C. (2020). Changes in hospital-based obstetric services in rural US counties, 2014-2018. Jama, 324(2), 197-199. https://jamanetwork.com/journals/jama/article-abstract/2768124
Leider, J. P., Meit, M., McCullough, J. M., Resnick, B., Dekker, D., Alfonso, Y. N., & Bishai, D. (2020). The state of rural public health: enduring needs in a new decade. American journal of public health, 110(9), 1283-1290. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2020.305728
Mehta, L. S., Sharma, G., Creanga, A. A., Hameed, A. B., Hollier, L. M., Johnson, J. C., ... & American Heart Association Advocacy Coordinating Committee. (2021). Call to action: maternal health and saving mothers: a policy statement from the American Heart Association. Circulation, 144(15), e251-e269. https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001000
Shah, L. M., Varma, B., Nasir, K., Walsh, M. N., Blumenthal, R. S., Mehta, L. S., & Sharma, G. (2021). Reducing disparities in adverse pregnancy outcomes in the United States. American heart journal, 242, 92-102. https://www.sciencedirect.com/science/article/abs/pii/S0002870321002258?via%3Dihub
Merkt, P. T., Kramer, M. R., Goodman, D. A., Brantley, M. D., Barrera, C. M., Eckhaus, L., & Petersen, E. E. (2021). Urban-rural differences in pregnancy-related deaths, United States, 2011–2016. American journal of obstetrics and gynecology, 225(2), 183-e1. https://www.ajog.org/article/S0002-9378(21)00144-7/abstract