Arguing with a Map

I don't doubt the underlying data about maternity care deserts in this NPR story, based on a March of Dimes report, but I have some arguments with the way the map looks:

(Note: both maps are viewable in much better versions on the March of Dimes report site.)

My arguments are based on my knowledge of the parts of the country I know best, Minnesota and central Upstate New York. I'm going to extrapolate my wondering a bit to a few other parts of the country.

Before proceeding, it's important to know what that map is based on, which is this map of the number of hospitals (with maternity wards) or birth centers in a county:

Not surprisingly, the light blue counties on this map are also light blue on the first map, and the dark blue counties are sometimes the red counties. 

My first argument is with the dark blue counties that aren't red or at least orange. For instance, all but two of those light-colored counties in Upstate New York on the first map are dark blue on the second map. Some of them are colored yellow — meaning they have moderate access — but many are are light blue, as if their access is just fine as is. Neither moderate or full access makes no sense to me, as a person who grew up there and knows how much rural and small-city poverty there is, how many people have no or unreliable transportation, and what the geography is like (the roads aren't straight, people!). 

Second, I don't understand why there are single counties on the first map anywhere in the rest of the country that have five or more hospitals or birth centers, surrounded by counties that are care deserts. Shouldn't the immediately surrounding counties be marked orange or at least yellow? If you're in a county adjacent to a county with at least five places to give birth, unless that county is gigantic, it seems like you have some access to it (see my next argument). 

Logically, shouldn't there be gradations of color, unless there's a geographic barrier in between? Look at Texas, for instance, or South Dakota. Do some of the hospitals prohibit people from adjacent counties from using their services? Why do counties without services in these states get labeled as care deserts, but not the ones in New York?

Third, not all counties are created equal in size, and their their hospitals and birthing centers are not centrally located. There are several counties on this map that are gigantic and are colored light blue, but I would be willing to bet money all of the maternity coverage is clustered at one end of the county, leaving a gap bigger than many noted for other entire counties. One obvious example is St. Louis County, Minnesota — that big slab of light blue running from the Canadian border to the western point of Lake Superior. The city of Duluth is at the very south end of the county, and with it almost all of the county's population, hospitals, and birthing centers. It looks like there is a birthing center in the small city of Virginia, but that's it for the rest of the county — nothing in the entire north half, which is larger than most counties in the country. I wonder the same thing about some of the gigantic counties in Arizona and southeastern California.

My third argument is a limitation of using counties for data representation, so I don't fault the study's creators for that, really — though I wish it could be acknowledged somewhere. The other two points are more substantive about how they have interpreted the data for translation into this visual.