Access to Maternal Care in the US Declines Amidst Growing Crisis
“It’s a crisis,” said Stacey Brayboy, the senior vice president of public policy and government affairs at March of Dimes. “Women are struggling to access care, and that’s before and during and after their pregnancies, and we’ve seen an increase in terms of maternal and infant deaths.”
Access to maternal care in the United States is becoming an increasingly critical issue. According to public health experts, the situation is expected to worsen in the coming years. Several factors contribute to this growing crisis, including financial struggles faced by obstetrics units, a rise in the number of uninsured individuals, and new anti-abortion laws that limit the number of physicians willing to practice in certain states.
The March of Dimes reports that roughly 5.6 million women live in counties without access to maternity care, while an alarming 32 million are at risk of poor health outcomes due to a lack of care options nearby. Notably, more than a third of all U.S. counties are considered maternal care deserts, with no access to reproductive health services. States with large rural populations, such as Alaska, Nebraska, North Dakota, Oklahoma, and South Dakota, are particularly prone to shortages.
The scarcity of maternal health care is especially severe in areas with higher instances of underlying health problems, such as hypertension and diabetes, and in states that have not expanded Medicaid, leaving hundreds of thousands uninsured. These factors contribute to the high and rising maternal mortality rates in the U.S. In 2021, the CDC reported that roughly 33 people died for every 100,000 live births in the country, a 40 percent increase from 2020. This figure is approximately 10 times higher than that of other industrialized nations such as Spain, Germany, Australia, and Japan.
Furthermore, the maternal mortality rate is disproportionately affecting non-Hispanic Black people, with a rate two-and-a-half times higher than that of non-Hispanic whites. The full impact of state abortion bans on maternal care has yet to be documented following the Supreme Court’s overturning of Roe v. Wade. However, a recent report reveals that states with restricted abortion access or pending court rulings have experienced a decline in access to obstetric care in recent years.
This decline in access to care is fueled by a financial mismatch faced by hospitals. Maternal care is expensive to provide, and reimbursements, particularly from Medicaid, are low. This poses a significant challenge for rural hospitals, which have a higher proportion of patients covered by government-run health insurance.
Alabama is one state experiencing severe consequences due to the declining access to maternal care. Between 2019 and 2020, the number of hospitals with labor and delivery services in Alabama decreased by 24 percent, with more closures anticipated. The Alabama Hospital Association warns that half of the state’s remaining hospitals are struggling financially and are at risk of closure.
The financial challenges faced by hospitals, combined with the lack of access to maternity care, put pregnant individuals at higher risk of adverse health outcomes. Lack of transportation and access to broadband also hinder the implementation of telehealth options, compounding the problem.
Similar issues exist in Wyoming, where five of the state’s 23 counties lack maternity care options within a 30-minute drive. The state’s vastness and limited infrastructure pose additional challenges for accessing care.
North Carolina, despite having fewer maternity care deserts than the national average, is also experiencing a decline in access to obstetric care. The number of hospitals with labor and delivery services decreased by 1.9 percent between 2019 and 2020. Rural communities in the state, particularly those with higher rates of chronic health conditions, are seeing an increase in maternal morbidity and mortality.
The recruitment and retention of OB-GYNs and other maternal health providers pose another challenge for hospitals. Idaho, for example, has seen a decrease in the number of birthing hospitals, with a high percentage of the state labeled as a maternal health desert. The state’s near-total abortion ban has made attracting doctors even more difficult, leading to concerns about the quality and availability of maternal care.
The declining access to maternal care and the subsequent rise in maternal mortality rates underscore the urgent need for action. Efforts to address the financial challenges faced by hospitals, expand access to comprehensive reproductive health services, and recruit and retain maternal health providers are crucial to mitigating this crisis.
Without immediate intervention, the United States risks further exacerbating its already alarming maternal mortality rates and perpetuating health disparities for marginalized communities.