ACOG Report Examines Full Scope of Maternity Care Access, Workforce Crisis in New York State

New York-Transportation challenges, unmet social needs, workforce instability and administrative burden are among the key factors limiting access to maternity care in New York State, according to a new report from the American College of Obstetricians & Gynecologists (ACOG)'s District II, which represents ob-gyns in New York State.

The report is based on a survey of ACOG's ob-gyn members and New York State Perinatal Association members, which include nurses, midwives, community health workers, doulas, and social workers. The report examines their perceptions of barriers to care and identifies potential opportunities for interventions to enhance patient safety and reduce health care disparities statewide.

When asked about barriers to accessing maternal care, respondents identified what they saw as the top challenges or stressors that patients face. Sixty-seven percent of respondents indicated that higher-risk pregnancies were a top challenge; 64% identified social determinants of health, such as lack of access to housing or food and transportation barriers; and 59% cited insurance-related issues, such as lack of health insurance coverage.

Among the social determinants of health that respondents said affected access to maternity care were insufficient or unreliable transportation options; difficulties finding or affording childcare; lack of access to housing; and safety concerns, such as fear of ICE or mistrust of health care systems.

"This report examines not only the thorny issues that exist for health care professionals when it comes to lack of access but also those problems that often inhibit patients from accessing care," said ACOG President Camille A. Clare, MD, MPH, CPE, FACOG. "Whether a patient with a high-risk pregnancy can't afford to come in until they're having a medical emergency or someone misses work to wait for a Medicaid cab that's 45 minutes late, these types of barriers must be recognized and addressed because they are what lead to poor health outcomes."

Seventy percent of responding health care professionals stated that they agree or strongly agree that there is a workforce crisis in all areas of maternity care in New York State. They reported that the most acute staffing shortages were among nurses, mental health professionals, and generalist ob-gyns; about half of respondents said these shortages lead to delays in care, overbooking, and excessive shift demands.

Administrative burdens are also taking a toll: Just over half of respondents cited cumbersome electronic health record documentation as a current challenge to providing patient care. Prior authorization and low reimbursement rates were named as other issues with insurers. About a third of respondents said care coordination between facilities or patients' other care teams is a stressor.

Under these circumstances, 61% of respondents indicated that they were dealing with burnout and stress. Among the professions, those feelings were experienced by 85% of physician residents, 68% of community or home care workers, 62% of nurses, 60% of active practice ob-gyns, and 59% of doulas.

"The factors that will make it challenging to maintain our health care workforce in New York are systemic," said ACOG District II Chair Mary Rosser, MD, PhD, FACOG. "Although New York is not in the same position as other states when it comes to maternity care deserts, we can't afford to not take our access issues seriously. Luckily, this is not a problem without solutions, and we hope that the findings of this report will help call attention to opportunities for change."

Among the solutions the report offers are:

• Fortifying the state's public health systems to address social determinants of health
• Prioritizing opportunities to invest in transportation infrastructure across the state
• Targeting interventions to ameliorate staffing shortages
• Addressing and alleviating administrative burdens
• Investing in systems infrastructure to improve care coordination

The report was supported by the ACOG Foundation and developed in partnership with Agency M, an independent market research firm. Avenue M fielded the survey in October 2025. A total of 457 surveys were collected with a completion rate of 82% and an overall response rate of 13%.

Read "Challenges to Maternity Care Access in New York State."