U.S. sees shameful rise in ‘maternity care deserts,’ study finds

desertsmaternitycaremod-300x209The national disgrace of expectant moms and infants suffering excessive, preventable injuries and death can’t be blamed on mysterious causes. Indeed, a leading advocacy group has put out yet another of its damning research studies, reporting on the disturbing increase in what it terms “maternity care deserts.”

The March of Dimes says it has analyzed data county by county to discover that too many areas of this country have “no hospitals providing obstetric care, no birth centers, no obstetrician/gynecologist, and no certified nurse midwives.”

The nonprofit organization classified an unacceptable number of counties “as having low access to maternity care services,” meaning they have “one or fewer hospitals offering OB service and fewer than 60 OB providers per 10,000 births, and the proportion of women without health insurance was 10 percent or greater.”

The country also has a chunk of counties the group described with “moderate access to maternity care,” meaning they have one or fewer hospitals offering OB service and fewer than 60 OB providers per 10,000 births, and the proportion of women without health insurance was less than 10%.”

Stacey Stewart, president and CEO of March of Dimes, told the science and medical news site Stat that the information compiled by the organization is distressing:

“Every time a new report comes out, we seem to be going in the wrong direction. You’re taking an already severe situation and it’s just getting worse.”

As the organization reported in its study:

“Nationwide, 5% of counties have less maternity access than just two years ago. These areas of combined low or no access affect up to 6.9 million women and almost 500,000 births in the U.S. In maternity care deserts alone—approximately 2.2 million women of childbearing age and almost 150,000 babies are affected … The 2022 report describes a 2%increase in counties that are maternity care deserts since the 2020 report. That is 1,119 counties and an additional 15,933 women with no maternity care.”

Stat described why maternity morbidity, mortality, and medical services’ deserts are a scandal for the U.S. health system, the world’s most expensive:

“The U.S. is in a maternal care crisis, with the highest maternal mortality rate among comparable wealthy countries — one that continues to increase year over year. Black women, in particular, are three times more likely to die as a result of pregnancy than white women. In light of other stressors on the health care system including the pandemic, staff shortages, and increased abortion restrictions across the country, experts worry that access to comprehensive reproductive care will continue to decrease, putting pregnant people and their babies even more at risk.”

“Fly-over America,” the swath of the country between the urban metropolises on the coasts, has the greatest number of counties with dismal maternal deserts. The center of the country is jammed with rural areas with small and shrinking populations and shuttering hospitals, clinics, and other medical facilities where OB-gyns would practice. Maternity care deserts also are more prevalent in parts of the country where conservative, Republican lawmakers have declined under the Affordable Care Act to expand Medicaid, the federal health coverage program for the poor and working poor.

Stat noted that NPR analyzed an earlier March of Dimes study on maternity care deserts and found them to be more likely to occur in parts of the country where politicians are taking the toughest stances against women’s reproductive health care, notably abortion services.

Abortion is a difficult issue, fraught with personal, religious, and other factors adding to complex personal and societal decision-making on the issue. But news organizations have found rising number of instances where specialists in women’s care, notably OB-gyns, say they are struggling to practice safe, quality medicine  due to extreme laws that bar abortion without exception, including without accounting for the health or life of the mother, rape, or incest.

While the color-coded graphics in the March of Dimes report show nationally where maternity care deserts abound, the journalists at Washington, D.C.’s WTOP radio deserve credit for quoting Stewart of the March of Dimes in noting that the DMV (the District of Columbia, Maryland, and Virginia) has its share of maternity care challenges, too:

“Nearly half of the counties in Virginia (47%) are considered either a maternity care desert with no access to care or have very limited access. Prince George and Pittsylvania counties are among the 32% of counties that offer no access to maternity care. Maryland does slightly better. About 4% of the counties, there’s one county in the state, [Summerset] that’s considered a maternity care desert,” Stewart said. Dorchester, Caroline, and Garrett counties have limited access. D.C. is considered a county by the survey, so it technically has no maternity care deserts, but Stewart said service is lacking in Wards 7 and 8.”

In my practice, I see not only the harms that patients suffer while seeking medical services but also the damage that can be inflicted on expectant mothers, babies, and infants due to various causes of injurious and even lethal mistreatment or bad care. These are among the health system’s most vulnerable and precious patients, and with the nation graying rapidly and birth rates declining, why aren’t we doing better by them?

As Stat reported, the March of Dimes has solid recommendations to improve maternal morbidity and mortality, especially in addressing maternity care deserts:

“The report proposes a number of policy solutions to improve access to care. It recommends expanding access to Medicaid based on income as well as expanding the postpartum coverage period to a full year, as opposed to 60 days; better integration of and access to midwifery and doula services, which can supplement physician care; and providing insurance coverage for telehealth maternity services, though the report recognized that poor broadband access limits how one may be able to access virtual appointments. The authors of the report urge lawmakers to pass the Black Maternal Health Momnibus Act.”

Advocates also have urged officials to better accept and expand programs that provide maternity services that don’t necessarily require only M.D.s but also those that offer patients the option of midwives and doulas.

We have much work to do to improve maternal and infant health care and to remedy its current awful situation.

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