Maternity Deserts, Low Access to Care Affect 5.6M Birthing People

Researchers said the increase in maternity deserts and poor access to care is in part due to the closure of obstetric wards.

A whopping 5.6 million birthing people are finding themselves without access to maternity care as the prevalence of maternity deserts continues to grow, according to reports from March of Dimes.

These care access issues are compounded by the social determinants of health that also impact maternal health outcomes, the report authors said.

The March of Dimes report comes as the healthcare industry grapples with a fraught maternal health problem.

Separate studies have found that the US has the worst maternal health outcomes and worst maternal health equity out of the developed world. On top of that, the Supreme Court’s reversal of Roe v. Wade has called into question overall access to all kinds of reproductive healthcare, not just abortion.

Now, March of Dimes is outlining the state of birthing and maternity care access, particularly by shining a light on maternity care deserts.

“A person’s ability to have a healthy pregnancy and healthy birth should not be dictated by where they live and their ability to access consistent, quality care but these reports shows that, today, these factors make it dangerous to be pregnant and give birth for millions of women in the United States,” Dr. Elizabeth Cherot, March of Dimes president and chief executive officer, stated publicly.

“Our research shows maternity care is simply not a priority in our healthcare system and steps must be taken to ensure all moms receive the care they need and deserve to have healthy pregnancies and strong babies,” Cherot added. “We hope the knowledge provided in these reports will serve as a catalyst for action to tackle this growing crisis.”

Overall, 5.6 million birthing people live in counties with no or limited access to maternity care services, a trend that’s driven in large part by the loss of obstetric units in hospitals. Hospitals in 369 counties have seen their obstetric units close down since March of Dimes first reported on the topic in 2018. That represents around one in 10 counties.

Worse, 70 more counties in the US have been deemed as maternity care deserts as the result of obstetric ward closures since the 2018 report. Altogether, 36 percent of US counties are considered maternity care deserts, defined as counties without a hospital or birthing center that offers obstetric care and without any obstetric providers.

Obstetric ward closures are happening in some cases because of low birth volume and rising costs, the report authors said. Citing American Hospital Association figures, the report said over 50 percent of births in maternity care deserts are reimbursed via Medicaid, which offers a lower reimbursement rate than private insurance.

This makes the obstetrics ward a prime area of closure for a hospital facing tight margins.

But this phenomenon ultimately has a negative impact on maternal health. According to the researchers, over 32 million women of reproductive age are susceptible to poor health outcomes because they can’t access reproductive healthcare. This is most common in rural states such as North Dakota, South Dakota, Alaska, Oklahoma, and Nebraska.

These care access issues, and the consequences they hold for maternal health outcomes, are compounded by the prevalence of social determinants of health. The report authors pointed out that the environment, socioeconomics, and even housing access and pollution can indicate limited access to prenatal care. This is particularly true for women of color.

Moreover, occurrence of chronic disease plays a big role in health outcomes, they added. Eight in 10 maternity care deserts have a large population of pregnant people with a chronic illness, some of which impact birthing conditions like preeclampsia and pre-term birth.

SDOH and chronic illness are more common in places that are already maternity deserts, the team said, increasing the burden on birthing people with limited healthcare access options.

March of Dimes said these data points indicate a need for high-level policy change. Particularly, legislation that funds and sustains telehealth access, state perinatal regionalization programs to expand access to care, and programs that expand the healthcare workforce are integral.

The organization also endorsed the Rural Maternity and Obstetrics Management Strategies (RMOMS) and Rural Obstetrics Access and Maternal Services (ROAMS) to be expanded in all states. That’s in addition to an endorsement for extending Medicaid postpartum coverage from 60 days to a full year in all states.

“Every baby deserves the healthiest start to life, and every family should expect equitable, available, quality maternal care,” Cherot said. “These new reports show that the system is failing families today but paints a clear picture of the unique challenges facing mothers and babies at the local level—the first step in our work to put solutions in place, and build a better future for all families.”

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