{"id":42,"date":"2026-08-18T17:10:41","date_gmt":"2026-08-18T17:10:41","guid":{"rendered":"https:\/\/shoeleathermagazine.com\/2026\/?p=42"},"modified":"2026-09-09T21:34:22","modified_gmt":"2026-09-09T21:34:22","slug":"america-has-a-maternal-health-care-problem-can-new-mexico-solve-it","status":"publish","type":"post","link":"https:\/\/shoeleathermagazine.com\/2026\/america-has-a-maternal-health-care-problem-can-new-mexico-solve-it\/","title":{"rendered":"America Has a Maternal Health Care Problem. Can New Mexico Solve It?"},"content":{"rendered":"

The state is shifting to a system of community care, one that could be a model for rural healthcare nationwide.<\/em><\/p>\n

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Hannah Joy Lumen while in labor at Memorial Medical Center in Las Cruces, New Mexico. Photo courtesy of Melissa Marie Lopez- Sullivan.<\/strong><\/figcaption><\/figure>\n

Melissa Marie Lopez-Sullivan sat on a park bench near the parking lot of Memorial Medical Center in Las Cruces, New Mexico, sipping on a Diet Coke. It was 11 a.m. on a Friday, and the first hot sun of spring scorched the asphalt. She\u2019d barely slept in the last 48 hours.<\/p>\n

\u201cI\u2019ve been here since Wednesday night at 7 p.m., I hope to go home by midnight tonight,\u201d Lopez-Sullivan said. \u201cMight or might not happen.\u201d<\/p>\n

The maternity ward had been short-staffed and had multiple patients in labor. Because Lopez-Sullivan\u2019s client was not an urgent birth, they were waiting on a \u201clong, slow train.\u201d At the 36-hour mark, they were all exhausted. The staff had turned over three times while Lopez-Sullivan remained by her client\u2019s side.<\/p>\n

\u201cWe were part of something collective, a small, intentional community gathered to support the emergence of new life, each of us carrying a different piece of care, but all rooted in the same purpose,\u201d Lopez-Sullivan said. \u201cAnd at the same time, I was aware of the system around us, how much of birth is shaped by timelines and expectations that don\u2019t always honor the pace of a human body.\u201d<\/p>\n

Doulas like Lopez-Sullivan provide non-clinical support to patients in the form of education, emotional and physical support. And in a state where access to maternal care is not a guarantee, doulas hold together a fraying system.<\/p>\n

New Mexico faces a severe maternal health crisis, with a maternal mortality rate of 28.0 per 100,000 births \u2014 almost double the national average. According to a March of Dimes report, over\u00a0one third<\/a>\u00a0of its counties are classified as maternity care deserts. These deserts are counties with no hospitals or birth centers offering obstetric care. Nationwide, over 2.3 million birthing people live in these deserts, which severely limit access to prenatal care and delivery services. In New Mexico and in the wider United States, it has been estimated that over\u00a080%<\/a>\u00a0of pregnancy-related deaths are preventable, according to the American Medical Association. These deaths are driven by limited care access, substance abuse and systemic inequities.<\/p>\n

The U.S. has the highest maternal mortality rate among\u00a0high-income countries<\/a>. The Commonwealth Fund found that this rate is three times higher than Canada\u2019s and six times that of Australia and Germany\u2019s. The maternal mortality crisis disproportionately affects women of color, particularly Black and Indigenous women, as a result of historical and systemic disparities, which persist even when education and income are considered.<\/p>\n

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A map of the maternity care deserts in New Mexico, measuring level of access to care. Courtesy of the 2026 March of Dimes report.<\/strong><\/figcaption><\/figure>\n

Attacks on reproductive health have changed the landscape for providers, and are further worsened by proposals from the Trump administration. Most recently, President Donald Trump proposed slashing $990 billion from Medicaid over the next ten years in his \u201cOne Big Beautiful Bill Act.\u201d The maternal\u00a0health crisis is also impacted<\/a>\u00a0by proposals for the FY26 budget, which recommends the elimination of ERASE MM, which supports maternal mortality review committees, perinatal quality coalitions and the CDC\u2019s Safe Motherhood Initiative. For New Mexico, cuts like this push an already vulnerable state to a breaking point.<\/p>\n

For New Mexico, cuts like this push an already vulnerable state to a breaking point. Medicaid plays an influential role in accessing reproductive care, as the state ranks first in the U.S. for the share of women of childbearing age (15\u201349) with Medicaid coverage.<\/p>\n

On April 16, The Department of Health and Human Services Secretary, Robert F. Kennedy was questioned by\u00a0a House committee<\/a>\u00a0on his commitment to addressing the U.S. maternal mortality rate \u2014 a goal that was supposed to be achieved as a part of \u201cMake America Healthy Again\u201d (MAHA) policy agenda. The Committee pressed him on the administration\u2019s funding cuts to research and safety initiatives; he answered that these actions reduced \u201cduplication.\u201d<\/p>\n

Birthing people have better outcomes when doulas are involved.\u00a0The National Institute of Health\u00a0<\/a>found that women who had doula care had 52.9% lower odds of cesarean delivery and 57.5% lower odds of postpartum depression and\/or anxiety, both life-altering issues for birthing people in America, particularly those of color.<\/p>\n

In New Mexico, doulas act as first responders and critical advocates for their clients, often providing their services at low or no cost. They are key pillars of community-centered birthing services, a holistic model of maternal care that prioritizes continuity of care, addresses social determinants of health and draws its providers from within the community itself.<\/p>\n

For years, being a doula has meant little state recognition and stigma \u2014 no Medicaid reimbursement, limited formal pathways for training, denial from hospitals during the pandemic and low pay. Until now.<\/p>\n

In the wake of the Trump administration\u2019s cuts, doulas in New Mexico, led by Lopez-Sullivan, demanded change. In the 2025 legislative session, the Doula Credentialing and Access Act (HB214<\/a>) was signed into law by Governor Michelle Lujan Grisham. The legislation establishes a credentialing pathway for doulas that allows them to become Medicaid providers and receive reimbursement for their essential services.<\/p>\n

A month after the birth, Lopez-Sullivan reflected on the difference this bill has made. \u201cTen years ago, sitting on that bench might have also come with the awareness that this labor, 36 hours of presence, care and attention would likely go uncompensated or under-compensated,\u201d Lopez-Sullivan said. \u201cIt was and is work rooted in commitment, yet often unsupported by systems.\u201d<\/p>\n

Experts have proposed a range of\u00a0solutions<\/a>\u00a0to the maternal health care crisis: reducing care gaps through increased access to midwives and doulas, increased insurance coverage, building of free-standing birth centers and creating specialized postpartum care models. But, New Mexico, at the crisis\u2019 ground zero, may already hold some of the answers on how to fix it.<\/p>\n

A Status Quo of Closure<\/h2>\n

In rural America, particularly in New Mexico, access to health care is not a guarantee. The state has become no stranger to watching the doors close on some of its most needed medical services. Within the last five years, 36% of rural New Mexico hospitals that offered birth services and free-standing birthing centres, have closed or diverted laboring patients because of staffing shortages and the cost of maintaining obstetric services.<\/p>\n

Closures of maternity services are contributing to the widening gap in access to maternity care for birthing people across the country. Across the nation in 2025, 27 rural hospital labor and delivery units closed or were planned closures, and nearly 24 freestanding birth centers closed or are currently facing substantial financial pressure. One of these birthing centers, Dar a Luz, is located in Albuquerque, New Mexico.<\/p>\n

A cluster of maternity care deserts sits in rural Northeast New Mexico, spanning five counties and 10,000 square miles. Located in this desert is Rat\u00f3n\u2019s Miners Colfax Medical Center, the only hospital with an obstetric unit for 100 miles. The nearest alternatives are in neighboring states \u2014 to the East, Amarillo, Texas and to the North, Pueblo, Colorado.<\/p>\n

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The drive on US Highway 64 on the way to Rat\u00f3n from Cimarron. Photo by Marisa Sandoval.<\/strong><\/figcaption><\/figure>\n

For miles leaving Taos, the nearest major city to Rat\u00f3n, the land stretches over the horizon with dispersed gas stations and rest stops as the only signs of life as the road climbs into the Sangre De Cristo Mountains. On the way, drivers pass through Cimarron, a town known as where \u201cthe Rockies meet the Plains.\u201d To reach the Medical Center from the south, this must all be navigated before a provider sees their patient.<\/p>\n

In a maternal health care desert, maintaining an OB department is accompanied by extreme financial strain. Chief of Nursing at Miners Colfax Rhonda Monoit explained the hospital spends nearly $3 million a year to maintain its services; most of which they do not get back. On staff, the hospital has two alternating OBGYNs, one flying in for her 15-day shift from the Pacific Northwest.<\/p>\n

Monoit emphasized the difficulty of finding doctors who are willing to do rural health care because of the dangers it brings \u2014 lack of access to neonatologists, limited blood availability and a helicopter required to transfer patients to a larger hospital. The rural location also leaves them at risk of receiving patients in imminent labor. Monoit explained that her OB manager, Dr. Jessica Roberts, \u201csacrifices\u201d her life to the department and \u201cdoes whatever it takes\u201d to provide care in the region.<\/p>\n

\u201cDr. Roberts literally just delivered one [a baby] literally off the highway,\u201d Monoit said. \u201cShe was in labor and they were traveling. Thank goodness there was prenatal care. But, she literally delivered as she walked in the door.\u201d<\/p>\n

Despite financial difficulties, the hospital\u2019s team is committed to keeping its OB unit open, knowing that if it were to close, patients would have to travel over 200 miles to a new hospital to receive care. With roughly two-thirds of U.S. rural counties losing population between 2010 and 2020, Moniot believes that without the availability of quality OB and prenatal care, these areas may \u201cshrivel up and die.\u201d<\/p>\n

Monoit wishes that insurance companies and policy makers would have to walk a day in rural hospital administrators and providers\u2019 shoes. \u201cWe struggle to fund having providers, to keep our doors open and the lights on,\u201d Monoit explained. \u201cIt\u2019s sad because it is where the future generations are being born.\u201d<\/p>\n

Brian Cotter, the Center\u2019s CEO, shared that some of the biggest challenges they face are Medicaid reimbursement rates and insurance denial rates. These issues are particularly prominent when payer agreements are challenged or approval processes are delayed. Cotter explained that although a hospital may get authorized to provide care for a Medicaid-covered patient, the rates negotiated in payer contracts \u2014 which are individualized to hospitals \u2014 are low in comparison to the costs the hospital endures. His hospital faces a 15\u201320% denial rate for insurance claims, this sits near the 18% average for rural hospitals which is much higher than the 10% denial rate for urban hospitals.<\/p>\n

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A labor, delivery and recovery room at Miners Colfax Medical Center. Photo by Marisa Sandoval.<\/strong><\/figcaption><\/figure>\n

\u201cYou got something that\u2019s going downhill and you\u2019re trying to save it, but it\u2019s always like you\u2019re pushing that boulder up the hill constantly,\u201d Cotter said as he explained what it is like to run a rural hospital.<\/p>\n

Miners Colfax has been designated as a \u2018critical access hospital,\u2019 which reduces financial vulnerability, allows it to provide 24-hour emergency services and receive cost-based Medicare reimbursement. But, this designation is rare. Cotter has seen other similar institutions without this designation be acquired by private equity firms, at the cost of the communities they serve.<\/p>\n

\u201cRural and urban hospitals have been closing their OB units left and right for the last several years because more and more private equity that gets into hospital ownership,\u201d Cotter said. \u201cThey typically want to turn and burn hospitals to squeeze their profits.\u201d<\/p>\n

Nationally, private equity firms are increasingly acquiring hospitals, with investment in health care reaching an estimated\u00a0$104 billion<\/a>\u00a0in 2024. Once under private equity ownership, the least profitable units are usually the first ones to go. Often, this is the obstetric unit. As maternity wards and other reproductive health care facilities disappear, they\u00a0continue to<\/a>\u00a0contribute to and further worsen the crisis of maternity care deserts. These acquisitions have been nationally linked to declining quality, with some\u00a0studies<\/a>\u00a0suggesting higher patient mortality rate, reduced staffing and rising costs for care.<\/p>\n

In the face of this, Monoit and Cotter have made it clear that they will not eliminate their obstetric or reproductive care services. After referencing their oath as nurses, they explained that their purpose as human beings is to protect and care for others.<\/p>\n

\u201cCommunity need is really what drives a hospital,\u201d Cotter said. \u201cWe are here because of the community, the community is not here because of the hospital. That is a big distinction.\u201d<\/p>\n

Located in the outskirts of Albuquerque, Dar a Luz Birth Center caught \u2014 or the word that midwives use instead of\u2018deliver\u2019 to highlight the active work of the laboring person \u2014 their first baby in April 2011. Over 15 years, the team expanded to become one of the nation\u2019s longest operating state-licensed birth centers, participating in the birth of 2,775 babies. As a freestanding birth center, they offered families a third space, one that bridged the gap between home birth and hospital settings. In December of 2025, the center lost its namesake.<\/p>\n

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The entryway to Dar a Luz Health Center in Albuquerque, New Mexico. Photo by Marisa Sandoval.<\/strong><\/figcaption><\/figure>\n

In early 2023, executive director and co-founder of Dar a Luz, Abigail Lanin-Eaves, realized that the math would not add up anymore. The increasing costs of medical malpractice insurance, low Medicaid reimbursement rates and the high burnout rate of midwives began to pile. It was clear to Lanin Eaves that they could not continue offering birthing services.<\/p>\n

\u201cI could see with the changes in health, the maternal landscape, our politics and healthcare that being a small health care organization with our healthcare system in this country is nearly impossible,\u201d Lanin Eaves said. \u201cIf you look around, there\u2019s almost not a single small health care business that is not doing medical spa stuff.\u201d<\/p>\n

The pivot from birth to a women\u2019s health center happened in a matter of months. The team had their last birth in December of 2025, and quickly renovated their birthing suites to ketamine therapy rooms. This offering assists the Center in maintaining financial stability, so the team can continue to offer other reproductive care services.<\/p>\n

Lanin Eaves, a retired clinical nurse midwife, has advocated for increased state support for midwifery as well as increased Medicaid reimbursement rates for doulas and free-standing birth centers, like her own. She believes that, for as strong of a maternal health care community New Mexico has, the state could do more to support it. Without further funding from federal and state entities, she fears that birthing centers may continue down a path of closure, and may cease to exist entirely.<\/p>\n

\u201cI\u2019m so enraged and I\u2019m so brokenhearted at what\u2019s happening,\u201d Lanin Evans said as she wiped a tear from her eye, her hand and voice shaking. \u201cWhen I look at what\u2019s happening to women and their babies after doing this for 15 years, thinking that somehow it would get better, to watch it fall apart in the way it has is such a sad place [to be].\u201d<\/p>\n

Lanin Evans has spent most of her career lobbying for state and federal policy changes. Yet, she continues to see articles published about New Mexico and maternal health care deserts nationwide. Despite her passion for birthwork, sometimes she feels helpless.<\/p>\n

\u201cWe are a country that, at its core, does not give a crap about women,\u201d Lanin Evans said. \u201cHow we care for pregnant people and their babies in this country, the services that we offer them, the way that they can give birth, where they can give birth and how their providers are reimbursed is so broken that it\u2019s no wonder we have the highest maternal mortality rate of any industrialized nation.\u201d<\/p>\n

The \u201cCourse Correction of Care\u201d<\/h2>\n

Prior to New Mexico\u2019s statehood, the maternal health landscape was in the hands of the local community. Practices were rooted in Indigenous traditions and those of the Hispano population \u2014 native residents of the Southwestern United States descended from Spanish settlers. For centuries,\u00a0curandera-paternas\u00a0<\/em>(Hispanic midwives) led birthing services, with more than\u00a0800 pateras<\/a>\u00a0practicing in the state in the early 20th century. With statehood, tradition and culture were no longer at the forefront of maternal healthcare.<\/p>\n

New Mexico is the ancestral home of the Pueblo, Navajo and Apache people \u2014 to this day, it spans 23 sovereign nations, each with unique heritages. The state has also become a melting pot of migrant communities, with nearly\u00a010.2%\u00a0<\/a>of the state\u2019s residents foreign-born in 2023, according to the American Immigration Council. Over time, these communities have had to adapt to medicalized practices and lost their traditions.<\/p>\n

Alongside Lopez-Sulivan\u2019s advocacy for Medicaid reimbursement, she is leading the charge in the reestablishment of community-centric care in New Mexico. She explained the vital role of returning to a \u201cvillage\u201d model for providing maternity and reproductive care services.<\/p>\n

\u201cThe reality is when we go back and we look at our history, this is how we gave birth, before medical industrial projects. Birth was in community with your sisters, mothers, aunties or grandmothers,\u201d Lopez- Sullivan said. \u201cWe\u2019ve lost that.\u201d<\/p>\n

The debate in New Mexico, she added, is over determining who determines what care looks like, and confronting the \u2018medical industrial complex\u2019 \u2014 or networks of for-profit corporations that supply health services. According to the National Library of Medicine,\u00a098.4% of births<\/a>\u00a0in America take place in hospitals, but in New Mexico, this was a forced norm that does not always reflect the cultural practices and traditions of local cultures. Rather than accepting this, providers are making health care work for the clients they serve by connecting culture to care.<\/p>\n

New Mexico consistently ranks amongst the top three of the poorest states in America, with a poverty rate that sits at\u00a016.2%<\/a>, according to the U.S. Census Bureau. Birthing people in New Mexico face devastating challenges during pregancy, ranging from long-distance travel to appointments to high rates of untreated mental health conditions. A March of Dimes\u00a0report<\/a>\u00a0found that 23.3% of birthing people in New Mexico recieve inadequate prenatal care, this is significantly higher than the 14.8% national average.<\/p>\n

Maternal mental health conditions like postpartum depression and anxiety impact an estimated one in five mothers in the United States \u2014 making mental health disorders a leading complication of birth, according to the\u00a0Policy Center for Maternal Mental Health.<\/a>\u00a0The New Mexico Commision on the Status of Women\u00a0found<\/a>\u00a0that mental health complications contribute to more than a third of pregnancy-related deaths in the state.<\/p>\n

While state funding availability for initiatives in maternal health care are slim, private investment in community-centric care has been leading change. The W.K. Kellogg Foundation serves as a key investor in maternal and child health in the state. Their funding is directed to community-based organizations, including baby-friendly hospitals, doula services and breastfeeding support.<\/p>\n

Michelle Guti\u00e9rrez serves as a Senior Program Officer for Kellogg foundation, in New Mexico her work is focused on addressing the lack of cultural inclusivity practices in health care. To do this, Guti\u00e9rrez looks back to history.<\/p>\n

\u201cWe are going to need our providers and institutions to understand the true history of medicalization of birth in New Mexico,\u201d Guti\u00e9rrez said. \u201cAll the things that we had before, how those things were dismantled, why they were dismantled and what we are going to do about it now to create an equitable, integrated system of care.\u201d<\/p>\n

The medicalization of birth sits at the forefront of many providers\u2019 minds as well as Guti\u00e9rrez\u2019s. Not as something that has just affected New Mexico, but the whole nation\u2019s access to care. She believes that although many American communities understand how mental, physical, emotional and spiritual health are all intertwined, the system that serves them does not.<\/p>\n

According to Guti\u00e9rrez, when culture is centered in care, there are better health outcomes. She has seen it herself. Guti\u00e9rrez explained that providing extra support in a state that is geographically vast with limited financial resources can be a challenge, particularly with federal impacts and anticipated cuts to Medicaid. But, she highlighted that New Mexico is often painted with a \u201clack\u201d perspective, and she believes that the conversation needs to be balanced.<\/p>\n

\u201cI\u2019ll speak for New Mexico, but I think this could be across the country. For many of our communities, we\u2019ve been forced or we\u2019ve been assimilated into this dominant \u2018US American cultural system\u2019 that isn\u2019t necessarily ours,\u201d Guti\u00e9rrez shared. \u201cThat misalignment is creating some of the health disparities that we are seeing currently.\u201d<\/p>\n

Disconnection between patient needs and clinical environments can lead to mistrust and inequalities in care.\u00a0Research<\/a>\u00a0by the Kellogg Foundation found that in maternal and infant health, specifically, the intersection of race, gender, poverty and other social factors shapes individuals\u2019 experiences and outcomes.<\/p>\n

As one of the most diverse states in the nation, with 50% of its\u00a0population<\/a>\u00a0identifying as Hispanic\/ Latino and 11.2% Indigenous according to the Department of Health and Human Services, providers are prioritizing care models that reflect the traditions and cultural practices of birthing people.<\/p>\n

Guti\u00e9rrez explained that although New Mexicans face real financial disadvantages, in terms of relationships and resilience, they excel. She shared that community bonds and human capital are often undervalued in conversations of wealth, but for New Mexicans, they are immeasurable.<\/p>\n

At the policy level, Guti\u00e9rrez and the Kellogg Foundation are working within the budget and tax space. They are advocating for the reallocation of resources unique to the state, like oil and gas revenue. Behind Texas, New Mexico is the second-largest crude oil producing state in the nation. According to the New Mexico Oil and Gas Association, the industry generated\u00a0$13.1 billion<\/a>\u00a0in state and local revenues in the 2025 fiscal year. Community-centric investors and organizations are looking for funding answers within the state rather than relying on volatile federal resources.<\/p>\n

Alongside this financial investment, Lopez-Sullivan is working on the ground to collaborate with doulas across the state to create a new status quo of care, one that prioritizes the community it serves. Their work focuses on centralizing the patient through building relationships, prioritizing trust, culturally and trauma-informed care and expanding the birthing and care options available to clients.<\/p>\n

\u201cWe are rebuilding the matriarchy, the village, the community and the relationships that actually sustain us,\u201d Sullivan said.<\/p>\n

To do this, providers across the state have found answers in coalitions.<\/p>\n

\u201cThere has been a shift in unity,\u201d explained Monica Esparza, the executive director of Changing Women Initiative, a non-profit organization seeking to renew cultural birth knowledge and reclaim indigenous sovereignty of women\u2019s medicine. \u201cCommunity-led initiatives served in silos, and so there was a replication of efforts and then decreased funding. Now I feel like community-led organizations have transitioned into working and collaborating together.\u201d<\/p>\n

She believes that it is important to support initiatives like theirs because it allows communities to reclaim birth led by the parent, rather than by practitioners.<\/p>\n

\u201cThe medicalization of it [birth] should be as a backup, should be in case of something of the need, in case of the need versus the norm,\u201d Esparza said.<\/p>\n

According to a\u00a02021 survey<\/a>\u00a0done by the New Mexico Pregnancy Risk Assessment Monitoring System, one in every three women statewide and about one in two Indigenous women did not receive prenatal care during their first trimester. Esparza and the Changing Women Initiative are cultivating a model for communities to grow their own lactation care support, midwives and birth teams. She sees this as a sustainable way to confront maternal mortality but also increase access to culturally informed care.<\/p>\n

\u201cWe\u2019re still seeing those high numbers of moms that are dying, and so there has to be a change, and there has to be a shift,\u201d Esparza explains. \u201cI highly believe that working with community, working with community practice providers in all formats around birth is going to help us shift those numbers.\u201d<\/p>\n

For over twenty-five years, Bold Futures has worked to build reproductive justice in New Mexico for women and people of color. To do this, they work in policy and advocacy, but also in cultivating a culture shift. Danica Terrones, a birth justice manager at Bold Futures, explains what she is seeing now is a \u201ccourse correction\u201d of maternal health care in the state.<\/p>\n

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Danica Terrones speaking at the Inaugural Maternal Health Day at the NM Roundhouse (February 2026). Photo courtesy of Danica Terrones.<\/strong><\/figcaption><\/figure>\n

\u201cThere is this emphasis of engaging with providers across the board about what New Mexican families need, based on research, the culture shift and on the conversations we\u2019ve had throughout the years,\u201d Terrones said.<\/p>\n

When partnering directly with organizations like Bold Futures on the ground, Guti\u00e9rrez has a three-pronged approach that focuses on geography, community engagement and race equity.<\/p>\n

\u201cWhen we think about racial equity, we think about our communities here in New Mexico, the majority of folks are communities of color or low income,\u201d Guti\u00e9rrez said. \u201cSo we\u2019re looking at the most vulnerable and marginalized populations, those who have not been present, particularly in decision-making roles.\u201d<\/p>\n

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