[co-author: Arianna Goberdhan]
We live in a world where exciting medical research promises to cure cancer, prevent heart attacks, and push back the effects of aging. Sadly, we also live in a world in which “maternity care deserts” are growing across the United States, leaving more women without access to essential care before, during, and after pregnancy, putting their lives and their children’s lives at risk.
What is a maternity care desert?
Any county where maternity services are inaccessible to mothers is considered a maternity care desert. In some cases, that means that there are no hospitals providing obstetric care, no birthing centers, and no obstetric provider. In others, it can mean that less than ten percent of the women of reproductive age are insured, meaning they can’t access maternity services even if they are available.
What’s the impact of lacking access to maternity care?
Being unable to access maternity care before, during, and after pregnancy can have devasting effects on both mothers and their children. When mothers don’t receive prenatal care, their babies are three times more likely to have a low birthrate and five times more likely to die; and for the mothers, the rates of maternal mortality and morbidities rises significantly. In the United States, the maternal mortality rate has increased from 17.4 deaths per 100 000 live births in 2018 to a staggering 23.8 deaths per 100 000 live births in 2020, with the rate for Black women nearly triple that of White women. It is yet unclear what role racial bias plays in clinician decision making while treating Black mothers. Unfortunately, our nation has the highest maternal death rate globally among high-income countries, nearly three times higher than France which has the second-highest maternal death rate.
Why do maternity care deserts exist?
Maintaining obstetric services within a hospital is expensive. In 2022, more than 40% of births in the United States were paid for by Medicaid, and hospitals argue that Medicaid reimbursements don’t cover the costs of providing care. This is especially significant in rural areas, where 18% of adults and 47% of children rely on Medicaid.
How many people are affected?
In the United States, more than 2 million women of childbearing age live in maternity care deserts; in 2022 those women gave birth to almost 130,000 children. An additional 3.5 million women of childbearing age have limited access to maternity care.
What can be done about it?
The current crisis in maternity care is complex, and solving it will require a combination of structural changes, including investing in child birthing centers and insurance coverage for midwife services and social and business shifts, including evolving more patient-centered care and connecting more women to behavioral and social supports).
These are long-term solutions, and although it’s important to advocate for them, it’s also important to ensure every woman who becomes pregnant knows she’s entitled to receive quality care, whether she has private insurance or Medicaid. As long as any woman doesn’t receive the care she needs to support a healthy pregnancy and post-partum period, our society is failing to deliver the most critical health outcome of all.
