Maternity care deserts grow across the US as obstetric units shut down

Lisa Desjardins:

The battle over access to reproductive health care in this country is largely focused on abortion. But often overlooked is a dire problem over where to give birth. In short and many parts of the country, there are fewer places to do it. Maternity wards or obstetric units have closed in many states this year, including New Hampshire, New York, Delaware, Florida, Mississippi, Texas, Wyoming, and more.

At least 7 million women of childbearing age live in so called maternity care deserts here in red. Those are counties with no obstetrics unit and no birth center. Those are places where midwives independently oversee delivery.

Earlier this weekend, I spoke with two experts on this issue. Alecia McGregor of Harvard University and Aubre Tompkins, the president of the American Association of Birth Centers.

Thank you both for joining me, Alecia, let me start with you. What is happening right now with the number of facilities that deliver babies in this country and how significant is it?

Alecia McGregor, Harvard University:

Without a doubt our system of obstetric care in the country is in a crisis. When we look at the number of maternity wards that have closed between 2006 and 2020, they are in excess of 400 across the country, some states have higher rates than others. So places like Pennsylvania, North Dakota, we see very high rates.

The hospitals that are most deeply impacted by maternity ward closures tend to be those hospitals that are known as black serving hospitals or Latino serving hospitals. So they have a greater share of black and Latino patients than other hospitals. In fact, hospital care tends to be relatively segregated even to this day. And that remains the case for at the hour of childbirth as well.

Lisa Desjardins:

Aubre, what about the support on the state level in some of these more red states? What does that look like with birth centers? Is there that support or is it not there?

Aubre Tompkins, President, American Association of Birth Centers: So we as a country have the worst outcomes of any developed nation, currently, you know, Alabama and Louisiana that are significantly low on the list. Unfortunately, a lot of state government agencies like health departments do not understand percenters are being educated and informed about birth centers from the wrong avenues from physicians and hospital systems that don't really understand birth centers. So they're working to put up obstacles and blocks to them.

So we need to have a lot of grassroots movement and education on the benefits of the birth center model and the midwifery model of care to improve these outcomes.

Lisa Desjardins:

I want to ask you both. How does the post Roe will affect all of this this area?

Aubre Tompkins:

One of the things that's important to remember in a post roe world is that in this country, if you are a black, brown, indigenous or person of color, and you become pregnant, you honestly and truly have to contemplate that you could die in our country. We have the worst maternal mortality outcomes of any nation, developed nation, particularly for black birthing people.

So you have the honest and true specter of death related to pregnancy. We have taken away the ability to decide whether or not to be pregnant. And we are also creating maternity health care deserts. So this is a crisis in our country that we need to address.

Alecia McGregor:

We know from our interviews with women and birthing people in two urban areas in the United States where we've done this research, that people have lost faith in the system of hospital care that we have. They don't feel safe in the clinical encounter, especially at such a vulnerable time in life as that of childbirth.

And so, the movement to start birth centers, there's a movement to start one in Boston, there are a couple in Washington DC. I'm hugely inspired by this movement for more community based models of care. I'm inspired by the women and birthing people who want to sort of take this process, this natural process and put it in their own hands. Because there's there has to be there has to be another way until we've until we've deeply reformed the system that we have.

Lisa Desjardins:

Such an important topic, Alecia McGregor and Aubre Tompkins. Thank you both very much.