New Rural Texas Maternal Health Rescue Plan calls for statewide “moonshot” to improve access to maternity care

The Rural Texas Maternal Health Assembly has released the second edition of the Rural Texas Maternal Health Rescue Plan, calling for a coordinated statewide strategy to improve access to maternal health care in rural communities, where maternity services continue to disappear despite recent state investments. TAFP is among five co-conveners of the Assembly.

The 2026 report, From Rescue to Moonshot, documents a rural maternity care system still under significant strain. Sixty percent of rural Texas counties are maternity care deserts — counties without maternity care services — and 65% of rural hospitals no longer provide maternity care. Among rural hospitals that continue to offer labor and delivery services, 20% are at risk of stopping. Statewide, inadequate maternity care access affects nearly 272,000 women and 18,000 births each year. 

The report also finds that 52% of Texas counties have no obstetric clinician, while another 7.9% have only one. Fifty-eight percent of rural counties lack sufficient primary care capacity, including one in five with no primary care physician — an important concern because primary care practices provide essential preventive and medical care before, during, and after pregnancy.  

“Research shows that when maternal care services close in a rural community, they practically never come back,” said Kia Parsi, MD, executive director of the Texas A&M Rural and Community Health Institute. “And we know pregnant moms in maternal care deserts have poorer outcomes, leading to increased morbidity and mortality. That is why the work of the Rural Texas Maternal Health Assembly is so important.”

The Rural Maternal Health Assembly first convened in 2024, bringing together more than 40 organizations representing rural health care clinicians, hospitals, academic institutions, consumer advocates, foundations, and other stakeholders. The group was created to develop a cohesive, consensus-driven set of state policy reforms aimed at improving rural maternal health access. 

The Assembly’s first Rural Texas Maternal Health Rescue Plan identified 12 policy priorities and placed the most urgent recommendations in a “Code Red” category. During the 89th Texas Legislature, lawmakers enacted three of the four Code Red priorities in whole or in part, including reforms involving rural hospital Medicaid payments, investments in the rural maternal health workforce, and funding for Texas women’s health programs. 

Those actions included passage of House Bill 18, the Rural Health Stabilization and Innovation Act, along with $150 million in enhanced biennial funding aimed at strengthening rural hospital financial stability. But the report notes that rural maternity care continued to contract: two additional rural Texas hospitals suspended labor and delivery services in 2025. 

“Rural OB nurses and physicians are incredibly resourceful, but resourcefulness should never be the healthcare system’s plan,” said Mandy Pugh, MSN, CNM, C-EFM, RNC-OB, rural representative for the Association of Women’s Health, Obstetric and Neonatal Nurses. “Mothers and babies deserve safe maternity care close to home, and rural clinicians deserve the support to provide it.” 

Following the 2025 legislative session, the Assembly reconvened, with the Texas Association of Community Health Centers joining the original conveners — the Texas A&M Rural and Community Health Institute, Texas Academy of Family Physicians, Texas Organization of Rural and Community Hospitals, and Texas Health Institute. The resulting second edition builds on the progress of the previous session while identifying additional steps needed to preserve and expand access to care. 

At the center of the new report is a call for a Healthy Rural Texas Pregnancy Moonshot — a multi-year, coordinated, visible, and funded state strategy designed to safeguard and extend maternal health services to rural women and measurably improve rural maternal health outcomes within five years. 

The report identifies four new Code Red priorities for state policymakers:

1. Modernize Medicaid maternal health delivery models and payments to improve the availability and timeliness of care provided by rural maternal health professionals.
2. Strengthen the rural maternal health workforce by expanding training pipelines and incentive programs for clinical and nonclinical health professionals committed to rural practice.
3. Sustain investments in rural hospitals and community health centers to protect maternity care services and build greater maternal health capacity and innovation.
4. Launch Project Healthy Rural Texas Pregnancies, a coordinated campaign and resource center to help rural communities increase access to and coordination of preventive and maternal health services. 

The report emphasizes that access to maternity care involves more than preserving hospital labor and delivery units. Healthy pregnancies also depend on timely preventive, preconception, prenatal, and postpartum care. Yet 22.8% of Texas women receive inadequate or no prenatal care, a rate higher than the national average, and access is even more limited in rural counties. 

“East Texas spans a large, mostly rural service area where distance, limited maternity capacity, and workforce shortages can delay routine prenatal care as well as urgent obstetric evaluation and transfer,” said Stephen Patrick, MD, professor of medical education and clerkship director for obstetrics and gynecology at The University of Texas at Tyler School of Medicine. “By advancing the recommendations of the Rural Maternal Health Assembly, the Legislature can give local health systems greater capacity to provide timely, coordinated, and safer care for women and families across rural East Texas — and indeed, every rural county.” 

The Assembly argues that without deliberate intervention, market forces alone cannot sustain essential maternal health services across sparsely populated areas of the state. Once maternity services disappear from rural communities, the report warns, they rarely return. 

The complete 2026 Rural Texas Maternal Health Rescue Plan: From Rescue to Moonshot is available at https://architexas.org/programs/maternal-health/index.html.

About the Rural Texas Maternal Health Assembly

The Rural Texas Maternal Health Assembly is a multidisciplinary coalition convened to identify and advance consensus-driven policies that improve access to maternal health care in rural Texas. The Assembly is convened by the Texas A&M Rural and Community Health Institute, Texas Academy of Family Physicians, Texas Health Institute, Texas Organization of Rural and Community Hospitals, and Texas Association of Community Health Centers, with participation from organizations representing health care professionals, hospitals and health centers, academic institutions, advocates, foundations, and other stakeholders.