In his 40 years as an obstetrician-gynecologist, Carl Smith delivered thousands of babies in the Midwest. Smith works at the University of Nebraska Medical Center and says many women of childbearing potential in the state have to travel dozens of miles just to see their provider.
“We have a large number of areas that are no longer providing maternity care due to the size of the hospitals and the low number of patients giving birth in some of our rural areas,” Smith told Yahoo News.
Because maternal care is limited, most women rely on primary care physicians for obstetric care. “And many of these patients end up having to travel several miles to see their local provider and several miles to deliver at a hospital that continues to provide obstetrics.”
“We go as far as 200 miles west of us to provide local counseling to obstetricians and gynecologists who care for patients locally,” he added.
According to a 2022 study by March of Dimes, a nonprofit dedicated to women’s and baby health, over 36% of counties in the United States share the same predicament, with none or very limited access to maternal care.
The study found that nationwide nearly 7 million women live in areas with minimal or no access to maternal care. “We coined this term ‘midwifery desert’ to describe a county that does not have a hospital that offers midwifery services, no other midwifery provider such as a OB-GYN, and no birth center,” Stacey Stewart, president of March of Dimes, Yahoo News said.
In this year’s report, the nonprofit found a 2% increase in the number of counties considered maternity care deserts compared to a study completed in 2020. “That is [an additional] 1,119 counties and an additional 15,933 women without maternity care,” the 2022 study said.
The lack of access puts the health of women of childbearing age and their children at risk, Stewart said. “Women have to travel 50, 60, 70 miles in a rural area just to get to the nearest obstetrician, to deliver a baby, or to go to a antenatal check-up.”
“The lack of access is a big part of why so many women are dying or near death from pregnancy, or why so many babies in this country do not live to their first birthday,” she added.
Of all the highly industrialized countries in the world, the United States is considered the most dangerous country to give birth in. “In any other highly industrialized country, we find that those countries take much better care of women’s health overall,” Stewart said.
Every day, two women die from complications related to pregnancy and childbirth, yet over 80% of these pregnancy-related deaths are preventable, according to the Centers for Disease Control and Prevention. The CDC found that the leading causes of pregnancy-related deaths are mental illness, excessive bleeding, heart disease, infection, blood clots, and high blood pressure.
But gaps in access to care are also a concern. “It’s very detrimental because every time you introduce distance as a variable of care, it tends to decrease the number of encounters and visits that patients will have,” said Brock Slabach, chief operations officer of the National Rural Health Association. to Yahoo News.
Rural areas make up most of the midwifery deserts in the country. In 2019, 47 hospitals across the country closed, double the number in 2018. “We know that the closure of hospitals and just a lot of providers didn’t choose to locate in many rural areas – or move out of rural areas – were a big challenge. ‘ Steward said.
But that’s not the only problem. Even the hospitals in the countryside cannot keep up with the financial burden. “Rural hospitals, by definition, have a lower volume because they’re small,” Slabach said. “These low-volume obstetric units have higher unit costs. And when you see that these unit costs are extremely high, reimbursements just aren’t enough to cover them.”
Peiyin Hung, associate director of the South Carolina Rural and Minority Health Research Center, noted that most rural hospitals rely on Medicaid insurance and reimbursements. Hung said Medicaid pays, on average, half what private insurance pays.
“We know that many women of color rely on Medicaid when seeking prenatal care,” Hung said. He said rural hospitals in communities with a higher proportion of African American women of childbearing age were more likely to close their work units.
Hung added: “Many rural hospitals are still under threat from OB [obstetrics] closures because they are in the red, and they have great difficulty recruiting new OB truck operators. And many of these existing OB providers in these communities are close to retirement. So we see a lot of red flags here.”
Medicaid, which covers about 40% of all births, is “the largest buyer of obstetric care in the United States,” according to Slabach. But unfortunately, Medicaid is a federal-state partnership. Therefore, all policies related to Medicaid payment and delivery of services are federally organized and federally controlled.”
As the number of deserters in maternity care increases nationwide, advocates are calling for changes to protect women’s maternal care. March of Dimes urges action at national level.
“We’re heading into the midterms,” Stewart said. “This is an important time for people, if they care about these issues, to actually elect policymakers, both Republicans and Democrats, who will take action on these issues.”
