A $2.8 million grant from The Leon Levine Foundation will expand a shared maternity care approach across 10 North Carolina counties classified as maternity deserts—areas where pregnant women often cannot access a local obstetrician, birthing hospital or certified nurse midwife.
Twenty-eight percent of North Carolina's counties lack basic maternity infrastructure. The March of Dimes has designated more than one-third of the state's counties as maternity deserts or low-access regions. Women in these areas often delay or skip prenatal care, and maternal and infant mortality rates climb. Rural communities bear this burden disproportionately, and the poorest families face the steepest barriers.
The shared care model trains and supports family medicine physicians in underserved counties to provide early and ongoing prenatal care. Those local doctors maintain consultative relationships with obstetricians in neighboring communities. When complications arise or specialized expertise is needed, the system connects patients to that expertise.
"This approach works because it acknowledges that continuity matters," said a statement about the program. "A woman who sees the same provider throughout her pregnancy builds trust, receives personalized care, and feels more comfortable disclosing vulnerabilities or health concerns."
The partnership driving the work includes Nurture NC, the North Carolina Community Health Center Association, NC Area Health Education Centers and the North Carolina Academy of Family Physicians.
The 10 targeted counties serve approximately 2,300 births annually—births that currently occur without adequate prenatal monitoring, postpartum follow-up or accessible emergency backup. Children born without prenatal care face higher rates of prematurity, low birth weight and developmental challenges. Mothers who lack postnatal support struggle more with depression, complications and recovery.
The grant funds expansion of a model rather than a one-time intervention, building capacity in healthcare providers and systems that will persist after the funding period. It creates infrastructure—training, protocols and relationships between local and specialist providers—designed to sustain itself by solving a structural problem.
Questions remain about long-term sustainability. Rural healthcare economics remain precarious, and even effective programs struggle to generate revenue needed for viability. Insurance reimbursement models will need to adapt to support shared care arrangements. Recruitment and retention of family physicians in rural areas remain challenging given broader physician workforce shortages.
Program leaders also must ensure that women of color, immigrant women and other marginalized populations within rural communities access the care, as geography is only one barrier among many.
These questions do not diminish the significance of the grant. Maternal health equity in rural America requires changes to payment systems, workforce development, immigration policy, childcare access, paid leave and transportation infrastructure. A well-designed shared maternity care program can work within existing constraints but cannot eliminate systemic barriers.
The investment removes one barrier and creates a replicable pathway for removing others. It demonstrates that solutions exist when geography is no longer accepted as destiny and systems are designed so that geography serves rather than controls access to care.
