[author: Verónica Vázquez]*
Seven million women of childbearing age currently reside in counties where there is no hospital-based obstetrics care, birthing center, OB-GYN, or certified nurse-midwife, The New York Times reported last month. Since 2015, dozens of obstetric units have closed in rural hospitals across the U.S., citing high operating costs, even as maternal deaths continue to increase at an alarming rate. In 2020, 47% of rural community hospitals did not provide obstetrics care, leaving women stranded in so-called “maternity care deserts.”
Maternity Care Deserts are Dangerous
Women living in maternity care deserts are at increased risk of pregnancy complications. They are three times as likely to die during pregnancy and the year afterward as those who are closer to care. If no nearby care is available, life-threatening complications such as hemorrhage, miscarriage, and amniotic fluid embolism become exponentially more dangerous.
Fewer than half of women in rural areas can find perinatal care within thirty miles, leaving them no choice but to travel long distances for important doctor’s appointments, sometimes in treacherous road conditions. For low-income families, it is challenging to scrape together gas money to travel to appointments.
Women of color are more likely to live in maternity care deserts or in communities with limited access to care. Native American women in particular are three times as likely to die from pregnancy-related complications as white women, and their babies are almost twice as likely to die during the first year of life as white babies. Pregnant women of color in low-income communities also grapple with chronic illnesses like heart disease, diabetes, and substance abuse at an increased rate, further complicating pregnancy.
Why Are Maternity Unit Costs so High?
Hospital obstetrics units are expensive to run. They must operate 24/7 with a full staff of on-call doctors, nurses, and backup services such as anesthesia and pediatrics. Maternity wards also use expensive equipment like infant security systems and ultrasound machines. Medicaid, which covers half of all pregnant women in the U.S., does not pay hospitals enough for maternity care services. In Washington State, for example, Medicaid paid only a third of what private insurance plans paid for a childbirth. For hospitals in low-income areas, there are not enough privately insured patients to help offset low Medicaid payments. Strained hospital budgets also take away providers’ ability to provide culturally sensitive care.
80 percent of maternal deaths in the U.S. are preventable. If maternity units in hospitals continue to close, that number will only rise. Preserving obstetrics unit in rural hospitals must be our top priority.
*Senior Associate
