Mothers without any pregnancy care is a shocking and risky reality all too common in the 21st century. Maternity care deserts are regions where access to safe maternity care is limited or absent. A multitude of health, societal and economic factors have left 7 million women of childbearing age living in counties with limited or no access to maternity care. These women are giving birth to more than 500,000 babies a year, putting them at risk of serious health complications. Addressing the maternity care desert crisis requires an understanding of how these deserts come to be, the risks they pose to mother and child and what solutions can be applied. Measuring a lack of access is largely determined by the distance a mother must travel to receive proper maternal care. A main driver to the increased distance is the closure of hospitals. A 2020 study by The Chartis Center for Rural Health found that 1 in 4 rural hospitals are at risk of closing. From 2010 up until last year this number of closed rural health care facilities had already reached 120. Low birth volume, private hospital ownership, a limited local supply of physicians, and location in a lower income county as several of the significant risk factors associated with these closures. With all this closure, a study by AJOG found that less than half of rural women live within a 30-minute drive to the nearest hospital offering perinatal services. In 2019 the U.S. Health Resources and Services Administration reported that counties with at least 1 hospital had a higher median income than counties with no hospitals. A cycle has begun where those most in need of care are already disadvantaged by lower income levels and face an additional barrier of nearby hospitals closing.
Hospitals that remain open in rural areas often lack adequate obstetric services. Despite 15 percent of our country’s population living in rural areas, only 6.4 percent of OB/GYNs work there. This is largely because over the years providers have migrated to wealthier urban hospitals leaving women in rural areas without care. In addition to traditional obstetric care providers, mothers living in rural areas are further isolated from the care of other essential birthing staff such as doulas. Doulas who are non-medical trained professionals to provide moms physical, emotional and informational support before, during and after childbirth are most likely to be utilized by women who pay out of pocket and live-in urban areas. This leaves those most in need of at-home birthing guidance with the least access to it including pregnant Medicare beneficiaries who tend to have lower household income.
We discuss increasing access to doulas and other methods of care as key solutions to combating this gap in care in Part 2: Filling the Gap.
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