In rural America, maternal health care is vanishing. These moms are most at risk.

Part 1 of a four-part USA TODAY project examining the lack of maternal health care in America's rural communities of color.

No maternal health care of any kind. Daniels, 33, had to drive about 70 miles round trip every other week for her prenatal appointments, and to deliver her baby. .

Living in places like Jasper and other maternal health care “deserts” puts people at risk for pregnancy complications and poor outcomes. Research shows this is particularly true if, like Daniels, they are Black.

In rural communities where at least a third of residents are Black, women in Jasper travel among the farthest in the nation for maternal care. The nearest maternity hospital is about 35 miles north across the Georgia border, but USA TODAY reporting found most go about 70 miles south to Gainesville for the specialized care they require.

About 2 million rural women of childbearing age live in maternity care deserts at least 25 miles away from a labor and delivery unit, a USA TODAY analysis found.

Rural hospitals and obstetric wards, already scarce, have continued to shut down in record numbers.

“We have higher-risk women that need more access but actually (are) less likely to get that access," said Tufts University professor Ndidiamaka Amutah-Onukagha, an expert on Black maternal health.

The maternal death rate for rural Black women is three times higher than for rural white women, a 2021 Government Accountability Office report found, and the rate of severe maternal illness for those Black mothers was twice that of white women.

At the same time, half of rural hospitals already had no obstetric care, and two dozen hospitals shut down entirely.

And it's an issue that affects those that live in rural communities, and particularly minority women.".

In December 2018, Congress passed the Improving Access to Maternity Care Act, directing the Health Resources and Services Administration to identify “maternity care health professional target areas” and distribute health specialists to those places.

The Trump administration, she said, didn't prioritize maternal health but under the Biden administration, there has been renewed attention to the issue.

The lack of accessible women's reproductive health care doesn’t affect communities equally.

Half of the nation’s rural counties have no obstetric care or OB-GYN practitioner, and rural Black communities, like Jasper, are more likely to lose their obstetric units, said Katy Kozhimannil, director of the University of Minnesota’s Rural Health Research Center, and Peiyin Hung, deputy director of the University of South Carolina’s Rural and Minority Health Research Center, who have been advising HRSA on the problem.

Rural communities with larger proportions of people of color are on average farther away from obstetrics than rural white communities, according to research by Hung and others.

Rural Indigenous communities must travel the farthest to reach care, the research shows. .

While the distances to maternity care hospitals from white and Black rural communities can be comparable, Hung noted rural Black communities tend to have lower health insurance coverage rates, the lowest median household incomes and lowest access to broadband, which hinders telehealth options.

Some women, such as those on rural American Indian reservations, must journey more than 100 miles one-way to deliver, according to a USA TODAY analysis of University of South Carolina Rural and Minority Health Research Center research and data from the U.S.

“There is a real problem in our rural communities around access to obstetric care.

And we know that that is worsened, both in terms of access and outcomes, for moms of color,” said Carrie Cochran-McClain, the National Rural Health Association’s chief policy officer.

Rural women on average have more babies than urban women. In Jasper, with no abortion services or a full-time primary care doctor, contraception can be expensive and difficult to get. A third of Jasper's Black residents live in poverty.

Over the past three decades, more than 300 rural hospitals have closed, disproportionately in communities of color.

Cochran-McClain, the rural health policy expert, said the rural hospital system has been historically underfunded. .

In 2020, the Department of Health and Human Services released the Rural Action Plan, its first agency-wide assessment of rural health care in almost two decades.

The Biden administration also included more funding in its 2023 budget proposal to expand HRSA's Rural Maternity and Obstetrics Management Strategies program and provide more primary care doctors with training in maternal health.

Coupled with lower birth volumes compared to urban hospitals, obstetric care is difficult for rural hospitals to maintain.

“The financial incentives in maternity care really work against access in ways that are important,” Kozhimannil said.

Lethenia “Joy” Baker has spent most of her career caring for women in rural Georgia. The state has one of the highest Black maternal death rates in the nation.

She has put in place specific strategies and protocols and is working to create new safety "bundles" through the Alliance for Innovation and Maternal Health for other hospitals to follow.

Baker, whose practice in LaGrange recently lost three specialists, called the health care "ecosystems" for women outside urban areas, "very, very fragile.".

Smith acknowledged the county has a maternal health care access crisis.

Such racial disparities aren't biological but are the result of structural neglect, said Tulane's Wallace. Her research found Black women living in Louisiana's maternity care deserts had the highest risk of death during pregnancy and up to a year after giving birth

Hawkins said she wishes distribution of health care were focused on "equity versus equality." Rather than treating everyone the same, care should be available and tailored to meet individual needs