111 Iowa L. Rev. 709 (2026)
Abstract
America is suffering from a maternal mortality crisis that disproportionately harms lower-income individuals and communities of color. Although access to comprehensive insurance coverage, quality housing, and healthy food reduces the risk of maternal mortality, the most vulnerable among us are often uninsured, live in neighborhoods that are unsafe, or are deprived of access to healthy food. The structural racism that pervades the U.S. health care system also contributes to the poor maternal health minority populations experience, leading to alarming increases in maternal death rates.
This Article adds an additional and routinely overlooked layer to this story. It argues that the maternal mortality crisis that is plaguing America is also the result of a wave of hospital mergers that has increased consolidation in the hospital industry, which has left vulnerable populations with no access to quality maternal care. The reason is twofold. First, post-merger, the acquiring hospital often moves to close essential health care services, especially obstetric care. Second, mergers help hospitals increase their market power in the labor market, which allows them to suppress the wages of their employees and offer employment under adverse working conditions. Because jobs in the hospital industry are primarily occupied by female workers, mergers end up indirectly harming women the most. In addition, public health research demonstrates a correlation among income, working conditions, and maternal health. As a result, the anticompetitive effects of hospital mergers are more likely to hurt the maternal health of lower-income individuals and communities of color who already struggle to improve their socioeconomic status and well-being.
But despite these obvious harms, antitrust enforcers and courts alike have failed to combat the harm hospital mergers pose to women’s prosperity and maternal health. This Article makes three proposals. First, antitrust enforcers and courts should object to any merger that reduces access to obstetric services, especially for residents in underserved areas. Second, they should accept mergers only under the condition that the merged entity will not cut obstetric services in rural communities. Third, they should assess the effects of hospital mergers on labor and, more specifically, on the wages and working conditions of workers in the hospital industry.
These proposals come at a critical time. Although the United States spends the most on health care in comparison to all other wealthy nations, it has the worst maternal mortality rates. Following the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which allows states to prohibit or limit access to abortion care, this trend will only worsen. In the wake of Dobbs, hospitals in abortion-ban states struggle to retain obstetricians because they fear criminal punishment if they offer women the full range of medical services for which they have received training. Mergers that reduce access to obstetric care can only hasten the further deterioration of maternal health brought on by the Dobbs decision. But by implementing the proposals outlined in this Article, antitrust enforcers can help mitigate the adverse effects of Dobbs on women’s health and alleviate the maternal mortality crisis that is harming the United States.