The Buzz This Week
Hospitals across the U.S. are closing maternity services in record numbers, creating “maternal care deserts,” which are defined as “any county in the United States without a hospital or birth center offering obstetric (OB) care and without any OB providers.”
A hospital in eastern Long Island, New York, this week shuttered all maternity services; a hospital in Troy, Ohio; announced it is closing its labor and delivery unit on February 29; and a hospital in Blacksburg, Virginia, is closing its OB services on April 1. While most closures are rural areas, even urban hospitals are cutting maternity services. For instance, a hospital in New York City recently announced it is terminating its midwifery program on March 3. These are just a few examples of what has become a steady stream of news since the beginning of the year.
Longitudinally, more than 400 maternity programs closed nationwide between 2006 and 2020. In rural communities, the disappearance of OB services has been particularly impactful. Between 2011 and 2021, 267 rural hospitals closed OB services, representing 25% of all rural OB units in the U.S.
Maternity services typically include care throughout pregnancy, during labor and delivery, and the postnatal period. Without these services, there is a higher risk of maternal and fetal injury or mortality due to complications, such as blood clots, preeclampsia, infection, stroke, excessive blood loss, and obstructed labor, among others. Many of these conditions are preventable or treatable if caught early enough.
The Centers for Disease Control and Prevention (CDC) reports that more than 80% of deaths associated with pregnancy are preventable in the presence of adequate maternal care. But when OB services disappear, expecting mothers must travel farther to receive care. In more than 200 rural communities that lost access to OB services from 2011 to 2021, pregnant women must spend an additional 15 to 45 minutes traveling to reach care.
Why It Matters
For many years, the U.S. has had the highest maternal mortality rates compared to other developed countries. In 2021, maternal mortality in the U.S. was nearly 33 deaths per 100,000 people, which is almost double what it was just 3 years prior. Other high income countries, such as Australia, Austria, Israel, and Japan, only report between 2 and 3 deaths per 100,000 people. Additionally, the U.S. maternal mortality rates are even worse for minority populations, with nearly 70 deaths per 100,000 among Black women in 2021.
The growing number of closures and widening maternal care deserts will likely only further exacerbate access disparities. The March of Dimes has estimated that 2.2 million women of childbearing age live in maternal care deserts—impacting 150,000 babies each year. Combine this with high rates of patients who are uninsured and underinsured (particularly in rural America), and access to maternal care for those who reside in maternal care deserts is bleaker. Solutions are needed.
To reduce maternal health deserts—or at the very least slow the growth trend—the causes must first be understood. These include:
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Financial challenges, such as low reimbursement for OB services; the high cost of running a labor and delivery unit or a neonatal intensive care unit (even at the lowest acuity level); and high malpractice insurance costs.
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Low volume, stemming from a small surrounding population and declining birth rates.
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Physician shortages, especially in rural areas. Just 7% of OB providers work in rural areas, yet 20% of the U.S. population lives in rural areas.
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Staffing shortages, which include experienced nurses, nurse anesthetists, and other clinicians.
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Policy changes, such as the Dobbs ruling, which is resulting in some OB-GYNs leaving states with anti-abortion laws. Similarly, new OB-GYN physicians are increasingly choosing to practice in states without anti-abortion laws.
Given the breadth and complexity of these challenges, there is no singular solution. Rather, a combination of programs and initiatives will need to work in concert with one another. These could include, but are not limited to:
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Expanding telehealth to cover areas where gaps exist. This would require partnerships between hospitals in maternal care deserts and hospitals with a decent sized OB-GYN program.
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Running OB-GYN rotations from hospitals with established maternity programs to those in maternal care deserts for prenatal care services. A full hybrid model would include patients traveling to the larger hospital where the OB-GYN originated for labor and delivery.
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Launching mobile OB units to reach underserved areas. The CARE for Moms Act, which is not yet passed, includes proposed grants for rural obstetric mobile units.
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Creating incentive programs to encourage OB-GYNs to practice in rural areas.
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Extending Medicaid postpartum coverage from 60 days to 12 months.
Innovation- and collaboration-driving ideas like these will be key factors as healthcare leaders and legislators devise solutions for addressing America’s maternal care crisis.
RELATED LINKS
March of Dimes:
Maternity Care Deserts Report
JAMA Forum:
Maternity Care Deserts in the US
Health Services Research:Why Are Obstetric Units in Rural Hospitals Closing Their Doors?
Regis College:
The Importance of Maternal Health Care
Editorial advisor: Roger Ray, MD, Chief Physician Executive.
