A new study from Birth Injury Lawyer Group finds that Arkansas ranks as the third most dangerous state to give birth, with a risk score of 69.0. The state has only 98.1 obstetric clinicians per 10,000 births. Midwives attend just 0.4% of its births. Federal projections show the same gap widening nationwide. The United States is expected to meet 86% of its OB-GYN demand by 2038. Nonmetro areas are expected to meet only 54%.
The findings draw on the study’s state birth safety rankings and HRSA’s maternal health workforce projections, which point to a national shortage of 7,660 full-time-equivalent OB-GYNs.
Key Findings
- Nonmetro areas are projected to meet 54% of OB-GYN demand by 2038, a 46% shortfall.
- HRSA projects a national shortage of 7,660 full-time-equivalent OB-GYNs by 2038.
- More than 4 million women aged 15 to 49 lived in counties with no OB-GYN in 2023.
- Only 4.1% of OB-GYNs worked in micropolitan or noncore areas, which hold 10.2% of women of childbearing age.
- HRSA projects a potential surplus of 4,610 nurse-midwives and certified midwives by 2038.
Where the OB-GYN Cliff Hits Hardest
| Indicator | Figure |
| Projected national OB-GYN shortage by 2038 | 7,660 FTEs |
| National OB-GYN demand met by 2038 | 86% |
| Nonmetro OB-GYN demand met by 2038 | 54% |
| Share of OB-GYNs in micropolitan and noncore areas | 4.10% |
| Share of women of childbearing age in those areas | 10.20% |
| Arkansas obstetric clinicians per 10,000 births | 98.1 |
| Arkansas births attended by midwives | 0.40% |
Why This Matters Now
The national number hides the real problem. On paper, the country is short by 14% of the OB-GYNs it needs. In rural counties, the gap is more than three times that size. The doctors exist. They are just not where the patients are.
You can see that in the split. Only 4.1% of OB-GYNs work in micropolitan or noncore areas. Those areas are home to 10.2% of women of childbearing age. In 2023, more than 10.1 million women lived in a county with no OB-GYN at all. For them, prenatal visits, delivery, and postpartum checkups all start with a drive.
Arkansas is not alone. Mississippi, Alabama, Oklahoma, and Texas also rank poorly for obstetric clinician availability in the study. Several of those states also show up among the worst for maternal mortality, preterm birth or maternity care deserts. That overlap does not prove one causes the other. It does give reporters a number they can trace behind the wider geographic divide.
The timing matters. March of Dimes released its 2026 maternity care deserts report on Aug. 11. It found that 57.9% of rural counties have no obstetric clinician today. HRSA’s projections suggest that the picture gets worse through 2038 unless staffing changes.
The Midwife Paradox
HRSA counted 14,540 nurse-midwives and certified midwives in 2024. It projects a potential surplus of 4,610 by 2038. That surplus sits next to a shortage of 7,660 OB-GYNs. GAO has reported that midwives can help fill provider shortages and improve maternity outcomes. So the workforce may already exist. The question is whether licensing rules, reimbursement rates, and hospital privileges keep midwives out of the places that need them most.
About the Study
Research by the Birth Injury Lawyer Group ranked states on birth safety, including obstetric clinician availability and midwife attendance. The national workforce projections above come from HRSA’s Bureau of Health Workforce, not from the client’s study.
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