Watching a government defend the removal of its own safety net while mothers are dying at rates that would shame most developing countries is almost surreal. In his Senate appearance last week, Health and Human Services Secretary Robert F. Kennedy Jr. made precisely that argument in support of a federal budget that would do away with Title X, Healthy Start, and the CDC’s Safe Motherhood and Infant Health Portfolio. Nearly all of the programs in place are designed to prevent American women from dying while attempting to conceive.
It’s difficult to ignore the timing. Among high-income nations, the United States already has the terrible distinction of having the highest rate of maternal mortality. Over 85% of those fatalities are thought to have been avoidable. However, the budget currently being supported in Washington would eliminate funding for the very infrastructure that is meant to stop them.
It is hard to dispute the narrative that the numbers present. Currently, Medicaid covers over 40% of births in the US; in rural areas, this percentage rises to almost 50%. That number rises to 64% among Black mothers. It is more than 58% for Hispanic moms. These are not underprivileged groups living on the periphery of the healthcare system. In many ZIP codes, they are the healthcare system. From this perspective, cutting Medicaid postpartum coverage—which was only recently extended to 12 months in almost every state—does not appear to be fiscal policy. It appears to be a choice made by individuals who have never once been concerned about locating a doctor nearby.
You can begin to grasp what a maternity care desert actually means in practice—not as a policy term, but as lived geography—by taking a stroll through some counties in Mississippi or rural Appalachia. Currently, one in twelve American women reside in places where perinatal care is not significantly accessible. Compared to over 82% of white women, only roughly 65% of Black women received early prenatal care in 2024. That gap did not appear out of nowhere. Decades of disinvestment are reflected in it, and the current course of policy indicates that the disparity is likely to grow.
In the meantime, the House passed legislation rerouting federal funds to unregulated pregnancy centers, which seldom provide real clinical prenatal care and frequently lack medical licensure. It’s still unclear if decision-makers are motivated by something else entirely or if they actually think this is a useful replacement for medical care. However, the practical outcome is the same in both cases: women who seek assistance wind up in places that are unable to assist them.
Public health researchers believe that this budget battle is distinct from others because of the scope of the issues being addressed, including Title X, Healthy Start, Safe Motherhood, and Medicaid itself, which points to something more systematic than typical budget cuts. For years, researchers at organizations like the National Institutes of Health and the American College of Physicians have documented how access to family planning and prenatal care directly lowers maternal mortality, lowers rates of gestational diabetes and hypertension, and reduces racial disparities in outcomes. This body of evidence is uncontested. It’s simply being disregarded.
Black women in America are already two to four times more likely than white women to die from pregnancy-related causes; this disparity is so widespread and persistent that it defies all explanations save structural neglect. Sepsis rates and ER visits among pregnant women experiencing complications have already been connected to restrictive abortion laws in several states. The direction of travel becomes sufficiently evident when Medicaid cuts are layered on top of the removal of Title X.
This is not the construction of a pro-family policy framework, whatever that term may be. The data suggests a more concerning trend: the federal government’s commitment to preserving mothers’ lives is gradually eroding. It’s easy to determine who will experience that withdrawal first. They already reside in arid regions.
