United Way of New York City takes on maternal healthcare deserts

It’s no secret that the United States has the highest maternal mortality rate among its fellow high-income Western countries. What most people may not stop to think about, though, is that more than 80% of those deaths are preventable. The U.S. is also not the greatest place for newborns. The 2025 March of Dimes Report Card, for example, gave the country a D+ for its preterm birthrate, with half of American states receiving a D or an F. And while U.S. infant mortality rates have dropped by more than 90% over the past century, the country’s numbers in this area are also behind those of comparable Western nations. 

One might think that President Donald Trump, who in January proclaimed himself “the Most Pro-Life President in History,” would push his administration to invest tax dollars to prevent the deaths of women and infants. Instead, the opposite is happening: The administration’s Medicaid cuts, threats to Affordable Care Act subsidies, and cuts to other related programs amount to “the biggest setback to reproductive care in half a century,” according to an October report by CBS News.

As in so many other areas, philanthropy alone lacks the resources to solve the problem for the entire nation. But a public-private partnership administered and partially funded by United Way of New York City (UWNYC) that launched in 2024 is working to make at least a dent in the problem in America’s largest city. 

UWNYC has launched two programs aimed at addressing the issue of maternal healthcare deserts in New York City. The new work arose as a result of information gleaned via the funder’s support of mobile health clinics that screen underserved New Yorkers for issues like hypertension.

“About two-thirds of the people served through UWNYC’s mobile health clinics are women, many of whom are expecting or new mothers,” said United Way of New York City Chief Development Officer Melissa Browne. The clinics served 7,678 total patients between Aug. 2024 and June 2025.  “Through the mobile clinics work, we recognized the importance of providing culturally familiar care in underserved communities and ways to address persistently high rates of adverse pregnancy outcomes among Black and brown women.”

In addition to the mobile screening clinics, which serve expectant mothers alongside other New Yorkers, UWNYC has launched a doula training program that has trained 33 doulas  — birth coaches who also act as advocates and educators — 23 of whom are taking additional training that will allow them to bill Medicaid for their services. The funder hopes to reach 300 pregnant women by the end of 2026 via these doulas in hopes of creating a professional workforce able to earn a living while facilitating better outcomes for patients. A third program, in partnership with the direct service nonprofit CommonPoint, hosts baby showers that include health screenings. This work reached 70 women last year and similar events are planned for 2026.

Maternal care deserts affect rural and urban populations

Many of the barriers standing between pregnant women and maternal healthcare are present in both urban and rural areas. Thirty-five percent of U.S. counties are “maternal care deserts,” or places without any obstetric care practitioners at all, according to the Human Rights Research Center. Those deserts are on the increase and have been the subject of more attention since the Dobbs decision, but they existed even during the era of federal abortion protections. According to a 2023 study published in the Journal of the American Medical Association’s JAMA Forum, more than 400 maternal-care services closed between 2006 and 2020. 

The issue is worse in rural areas, which have a larger proportion of Medicaid patients than urban ones. The JAMA Forum paper reported that 9% of rural counties lost hospital maternity services from 2004 to 2014, while another 45% didn’t have maternal services to begin with. But while obstetrics services are theoretically more available in urban areas, low-income rural and urban residents alike face the hurdle of affording them. 

Then there’s the issue of getting to those services. Having to travel to another community for basic maternal care adds time off work and travel costs to the burdens for both low-income rural and urban residents. And that’s assuming expectant parents have access to transportation at all. In October, the Natural Resources Defense Council estimated that 36% of Americans aged 10 and up “do not or cannot rely on a personal vehicle to meet their daily travel needs” and that nearly 16 million U.S. residents live in households that don’t have a car. 

Difficulty travelling to a maternal care appointment may seem like a rural problem, but underserved urban populations can also face transit challenges. While New York is known for its public transit systems, those systems don’t serve all residents equally — often excluding expectant mothers and people with disabilities.

People think “there’s trains everywhere” in New York City, Browne said, but “we know in communities in Queens, Brooklyn, the Bronx, there are actual transportation deserts.” Compounding the issue, Browne said, is that even the healthcare clinics that do operate in these areas are frequently not staffed appropriately — and that’s before accounting for the fact that someone experiencing a pregnancy complication may not be in the best shape to walk to a bus or subway stop, let alone navigate subway stairs and transfers.

To help with that challenge, mobile clinics funded by UWNYC use what Browne called a “closed-loop referral” process, diagnosing problems and then helping patients to get treated immediately, including for potential pregnancy complications. “We’ve had spaces where we’re doing a screening … and someone will be at high risk for a heart attack, or their blood pressure is really high or etcetera, and we’ll immediately go get them urgent care,” she said. “We’re making sure that we’re not just doing the screening,” but that if an alarming finding comes up, “we’re going to get you urgent care right away, and then we follow up with folks.” Meanwhile, UWNYC’s trained doulas and the baby showers with health screenings provide important support to expectant mothers via relationships and events designed to make them feel more assured in seeking care. 

Improving maternal and newborn health outcomes isn’t just about mothers and babies. “Many communities impacted by maternal health deserts experience cycles of economic instability, poor health outcomes, and a lack of trust in healthcare systems,” Browne said. “Our work addresses these gaps, protecting mothers and children while contributing to healthier, resilient families in underserved communities overall.” 

Disparities in maternal mortality due to implicit racial bias

Of course there’s also a big, woolly mammoth in any room where the high rates of U.S. maternal and infant mortality are under discussion: racial disparities. Pregnant Black American women die at 2.6 times the rate of white expectant mothers, and in New York State, Black women have a maternal mortality rate four times that of white women, according to a 2023 JAMA study provided to Inside Philanthropy by UWNYC. A 2025 study by KFF found that babies born to Black and other women of color also “have markedly higher mortality rates than those born to white people.” 

The problem, Browne said, “is implicit bias and racial discrimination.” That very bias put Browne at risk during her own pregnancy. When she was pregnant with her now six-year-old, Browne developed complications and was referred to a hospital by her OB. 

“I go there, doubled over in pain, and was dismissed,” Browne said. As the physician asked Browne a series of questions, including the date of her last period, Browne’s pain made it difficult to answer. “And he yells out to everyone, ‘She doesn’t know when she got pregnant!’” Fortunately, she said, a nurse eventually stepped in to help her.

“Now, obviously, I’m educated,” Browne told Inside Philanthropy. “I can speak for myself. But I couldn’t imagine if, one, I was an immigrant and didn’t speak the language, or two, I had no healthcare or a regular doctor.” Ultimately, Browne said, “a lot of what we’re trying to tackle is education. That’s why the doula programming is so important.” Doulas advocate for economically disadvantaged pregnant women and help them navigate a healthcare system that may otherwise ignore their needs.

Other ways foundations can support better maternal health

So what’s philanthropy to do in an era when the federal government has retreated from the struggle to improve the maternal and infant mortality rate — and is actively hostile to efforts to reduce racial disparities in the deaths of mothers and infants? UWNYC’s maternal health work embodies the possibilities of direct services that reach pregnant women.

Michigan Health Endowment Fund CEO Neel Hajra, meanwhile, has some ideas about an overall strategic approach for funders seeking to help nonprofits address “the new normal” of slashed federal funding. 

“Philanthropy should play several distinct roles,” Hajra said, to safeguard maternal and infant health. The most urgent priorities are “recognizing immediate opportunities to mitigate negative impacts,” Hajra said, to “help preserve critical resources and services that would be difficult to restart if shut down.”

Launched in 2023 with a $1.56 billion commitment from Michigan Blue Cross/Blue Shield, the Michigan Health Endowment Fund in March is launching the Healthy Kids Initiative to make grants of up to $750,000 to organizations “enhancing maternal health and infant outcomes” and other efforts. 

Hajra pointed to the fund’s collaboration with two other Michigan-based foundations during last fall’s government shutdown as an example of impact mitigation; the funds stepped in to provide financial relief to food stamp recipients. 

UWNYC-funded maternal health in the face of federal government disinterest can be seen as an example of preserving critical resources, as can the Michigan fund’s support of Michigan’s Pregnancy Risk Assessment Monitoring System (PRAMS) after federal funding was cut to that program, which houses data related to maternal health that’s used to guide public policy.

Philanthropy’s third, longer-term calling in these times, Hajra said, is to help communities and navigate the ongoing fallout from slashed federal funding, whether by engaging in more public-private partnerships at the state level or partnering with private businesses. 

“What the sector can’t do is indefinitely replace government funding,” he said. “Every dollar philanthropy spends backfilling core government services is a dollar lost for programs and investments that complement public services.”

There are also other routes that funders can pursue to create change on a wider range of issues that also impact maternal and infant mortality rates. For example, in 2023, Arnold Ventures pledged more than $1 trillion in infrastructure spending, including on transportation. Google and other funders are also backing the idea of a guaranteed basic income, as my colleague Connie Matthiesen reported last year. 

The current moment has indeed provided philanthropic funders with a plethora of “immediate opportunities to mitigate negative impacts,” as Hajra put it, and to help preserve critical programs. All foundations need to do now is pick a lane and keep it paved.