Maternal Care Deserts: A Growing Crisis in Rural America

For pregnant individuals in rural areas, accessing adequate maternal healthcare is becoming increasingly challenging, with potentially life-threatening consequences. A combination of factors, including hospital closures, limited specialist availability, and restrictive healthcare policies, is creating maternal care deserts across the United States, disproportionately impacting those with low incomes and limited access to resources.

The Growing Problem of Maternal Care Deserts

Pregnant people in rural areas are twice as likely to experience complications compared to their urban counterparts. This disparity is often due to the significant distances – sometimes up to 100 miles – individuals must travel to reach care, a barrier in itself. The lack of healthcare access directly contributes to preventable deaths, particularly in states like Texas, which has a large rural population and, between 2018 and 2022, recorded the highest number of childbirth-related deaths in the country.

Factors Contributing to the Crisis

• Infrastructure Issues: Maternal care deserts are fundamentally an issue of inadequate healthcare infrastructure, including a shortage of obstetricians, maternity wards, birth centers, and midwives in rural areas.
• Hospital Closures: Rural hospitals are more vulnerable to closure, further limiting access to essential maternal care services. Existing rural hospitals may struggle to maintain maternity wards due to financial constraints.
• Low Medicaid Reimbursement Rates: Providers are often forced to balance the financial realities of Medicaid’s historically low reimbursement rates, impacting their ability to provide comprehensive care. Medicaid covers roughly 50 percent of births in rural areas.
• Restrictive Abortion Laws: New laws surrounding abortion create legal uncertainty and, in effect, contribute to the creation of maternal care deserts in both rural and urban areas.

The Impact of Policy Changes

Recent policy changes, particularly the adoption of new abortion bans, have further complicated access to maternal care. Hospitals may delay or withhold care as they navigate these evolving legal landscapes, potentially endangering patients. Instances have been reported where standard procedures, like dilation and curettage (D&C), were delayed due to hospital policies, putting patients’ lives at risk.

U.S. Maternal Health Outcomes Compared Globally

Despite its wealth, the United States lags behind other developed nations in maternal health outcomes. The World Health Organization ranks the U.S. 55th globally, with an average of 22.3 maternal deaths per 100,000 live births. In contrast, Canada averages around 10 deaths per 100,000 live births, and Norway averages just two.

Community-Based Solutions

Addressing the maternal care crisis requires innovative solutions, particularly at the community level. Some initiatives include:

• Community Service Centers: These hubs provide general care, connect patients with specialists, assist with insurance paperwork, and offer transportation support.
• Mobile Clinics: Mobile clinics can effectively fill gaps in care by offering prenatal and postnatal care, STI screening, and breastfeeding support, often at lower costs than traditional facilities.
• Midwifery and Doula Support: Increasing the number of midwives and doulas, particularly in rural areas, can improve access to care and support during pregnancy, and childbirth. Midwives are associated with fewer interventions and higher patient satisfaction. Doulas provide non-medical support before, during, and after childbirth.

The Role of Training and Support

Expanding training programs for midwives and doulas is crucial. Although becoming a doctor or midwife requires extensive education, doula training is more accessible and provides valuable skills for supporting pregnant individuals and families within their communities.

Looking Ahead

The rising maternal death rates in the United States demand urgent attention and sustained investment in community-level support. With funding cuts to maternal healthcare research and services, the survival of pregnant individuals increasingly relies on grassroots efforts and a commitment to equitable access to care.

Sources:

Texas Health and Human Services – Medicaid and CHIP