Almost one-third of Iowa’s counties are considered “maternal care deserts” in a new report.

Stacey Stewart, president of the March of Dimes, says 29 of Iowa’s 99 counties are critically lacking when it comes to health care specifically for pregnancy. Stewart says women in those counties are at greater risk of complications from childbirth, including the death of the mother, the baby, or both.

“A maternal care desert is a county that lacks even the basic obstetrics services to help mothers safely deliver their babies,” Stewart says. “The county will not have even one hospital that offers obstetrics services and also not have any OBGYN or certified nurse midwife.”

Nationwide, about 35% of all counties fall into the maternal care desert category and Stewart says a majority of them are rural counties. “About 20% of all the women who live in maternal care deserts actually live in urban and metropolitan areas,” Stewart says. “It doesn’t mean that just because you live in an urban area, all of the sudden you’ve got all the resources available to you that you need.”

More than 700 American women die in childbirth each year and some 50-thousand suffer life-threatening complications, making the U.S. the most dangerous developed country in which to give birth. Women of color are most at risk of facing complications, and black women are more than three times as likely as white women to die from pregnancy-related causes.

“We have in the U.S. some of the worst rates of maternal mortality in the world,” Stewart says. “Our rates of maternal mortality have doubled over the past 25 years. What it means is that women are dying at higher rates as result of pregnancy and childbirth as compared to women in other developed countries around the world and that simply is unacceptable.” The March of Dimes is launching #BlanketChange, a social and video advocacy campaign focused on the iconic receiving blankets used to swaddle nearly every newborn baby.

The following 29 Iowa counties are listed as maternal care deserts: Adair, Adams, Audubon, Benton, Buchanan, Cedar, Clarke, Davis, Decatur, Franklin, Fremont, Grundy, Guthrie, Hancock, Harrison, Ida, Iowa, Jackson, Jefferson, Jones, Keokuk, Louisa, Lyon, Madison, Pocahontas, Ringgold, Sac, Winnebago and Worth.