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Maternity care deserts commonplace as more OB wards shutter

Obstetric ward closures and maternity care provider shortages are driving the growing trend of maternity care deserts nationwide.

Sara Heath
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Published: 11 Sep 2024

Maternity care deserts affect 5.5 million women nationwide, leaving them with no or limited access to maternity care services, according to the latest data from March of Dimes.

The data, published in the "Nowhere to Go: Maternity Care Deserts Across the US" report, indicate that poor maternity care access is mostly driven by hospital and obstetric unit closures.

"For too many families across the US, the ability to have a healthy pregnancy depends on where they live," Amanda Williams, MD, MPH, March of Dimes chief medical officer, said in a press release. "Our 2024 report underscores that maternity care is still not prioritized in our country and there is an urgent need for systemic changes to improve outcomes for moms and babies in the US and to ensure that these families have access to the care they need and deserve."

Currently, over 35% of U.S. counties are considered maternity care deserts, with North Dakota, South Dakota, Alaska, Oklahoma and Nebraska having the highest percentage of counties that are considered maternity deserts in the nation. In total, there are 1,104 U.S. counties without a single birthing facility or obstetric clinician, the report said.

These figures have far-reaching consequences. A total of 5.5 million women of any age live in a county that's considered a maternity care desert, while 2.3 million women of reproductive age live in such counties. All said, more than 150,000 babies are born to women living in counties that are maternity care deserts.

Living in a maternity care desert can often result in poor maternal health outcomes, the report continued.

For example, there were more than 10,000 preterm births among those living in maternity care deserts between 2020 and 2022, March of Dimes said. Living in a maternity care desert is linked to a 13% higher risk of preterm birth. Moreover, birthing people living in maternity care deserts are more likely to have chronic health conditions, like obesity, hypertension and diabetes, which can increase health risk during pregnancy and postpartum.

Unsurprisingly, there are some racial disparities at play. For example, about a fifth of Black women receive inadequate prenatal care compared to just 11% of white women. The risk of preterm birth is also higher for Black women overall and especially Black women living in maternity care deserts.

Maternity care deserts driven by OB ward closures

Getting to solutions for all women will first require an understanding of how maternity care deserts came to be in the first place. According to March of Dimes, limited access to maternity care is driven in large part by a dearth of birthing centers and hospitals in certain parts of the country.

One in 25 obstetric units in the U.S. have shut down within the past two years, leaving many birthing people without anywhere to go to receive care. Obstetric unit closures have been linked to increased travel times and greater stress on pregnant people, the report authors said. The typical drive time for those living in areas with full access to maternity care is 14.4 minutes; for folks in maternity deserts, it's 38 minutes.

Also driving maternity care deserts is a shortage of maternity care providers.

A third of U.S. counties lack a single obstetric clinician, with more OB-GYNs and family medicine providers continuing to leave the profession.

And there's little hope for other practitioners to fill in the gaps, the analysis continued. Although midwives are often lauded for their ability to fill in provider shortages and care access gaps, March of Dimes pointed out that 23 states have policies that limit midwives' abilities to deliver care at the top of their credentials.

Addressing maternity care access woes

There are a number of policy solutions the U.S. can consider to address maternity care deserts, March of Dimes suggested.

Foremost is addressing reimbursement and administrative barriers. Because Medicaid comes with administrative requirements and because it reimburses for births less than private insurance, it creates challenges for hospitals.

Next, policymakers might explore alternative payment models for maternity care. This includes looking at value-based payment models that include quality performance measures and financial accountability, the report authors said.

Additionally, experts might consider adopting Medicaid extension and expansion in all states. In particular, Medicaid extension -- meaning, individual enrollment in Medicaid for one year postpartum -- should be mandated via Congressional action, the report authors said.

Next, policymakers should review state regulatory barriers to maintaining and establishing birth centers.

Expanding opportunities for full midwifery integration is a key next step. This includes evaluating state regulations for granting licensure to certified midwives. It also includes ensuring reimbursement parity between midwives and physicians in both public and private payer contracts.

Finally, policymakers might consider investing in digital technologies and telehealth. In particular, ensuring patient access to affordable and reliable internet and mobile devices necessary for remote patient monitoring will be essential.

Sara Heath has covered news related to patient engagement and health equity since 2015.

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