Maternity care deserts are growing
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Half of U.S. counties don't have a hospital that provides obstetric care and more than a third lack a single obstetric clinician, according to a new report by March of Dimes.
Why it matters: Access to care is getting worse even as America's maternal mortality rate is more than double that of some other high-income countries, and the infant mortality rate recently rose for the first time in two decades.
The big picture: Obstetric care is suffering from larger demographic trends — including the overall decline in birth rates — along with, in red states, ripple effects from the Supreme Court overturning the federal right to abortion two years ago.
- But its problems also overlap with systemic health care problems, including the rise of chronic health conditions, stubborn gaps in insurance access, labor shortages, and deteriorating economic conditions for some hospitals.
- Counties that March of Dimes calls "maternity care deserts" — or counties with no hospitals or birth centers offering obstetric care and no obstetric clinicians — are disproportionately likely to be rural and are associated with a higher risk of preterm births.
Between the lines: In 2021 and 2022, at least 107 obstetric units around the country closed, per the report.
- The main reasons were low birth volume, insufficient reimbursement rates from insurers, and staff shortages, according to the report.
- Medicaid, which generally pays significantly less than private insurance, covered 41% of births in 2022.
- "Because of this, facilities and clinicians caring for lower-income patients face exceptional challenges in generating revenue for obstetric services," the report concludes.
The report found that 35% of counties, which are home to more than 2.3 million women of reproductive age, don't have a single birthing facility or obstetric clinician.
- Midwives could ease some of the shortage, but 23 states have laws restricting how much care they can provide, the report noted.
State of play: More than two dozen hospitals so far this year have closed maternity services, according to Becker's Hospital Review.
- Rural hospitals, which are generally struggling to retain viable business models, are often deciding that they just can't afford to keep the units open, the NYT reported last year.
- Patients in those communities then have to travel farther for care, and the closures tend to exacerbate health disparities.
The bottom line: Obstetric care is increasingly falling victim to the greater economic trends shaping the health care sector today.
- But the U.S.' maternal health outcomes are a clear indication that the status quo isn't working.
