Why the problem of maternity care deserts is getting worse

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• Geoff Bennett:

  The number of women dying of pregnancy related causes is on the rise with nearly 900 deaths reported in 2020. And two thirds of those deaths were determined to be preventable. That's according to a new report from the March of Dimes, a nonprofit organization focused on maternal and infant care. The report found that as outcomes get worse, so too is access to high quality maternity care. Ali Rogin has more.

• Ali Rogin:

  This new report found 36% of U.S. counties are maternity care deserts, places with no OBGYN doctors, hospitals providing obstetric care, birth centers or certified nurse midwives. Those counties are also home to 2.2 million women of childbearing age and almost 150,000 babies. These figures have worsened over the past two years with a number of maternity care deserts increasing by 2%. Two out of three maternity care deserts are rural counties, only 7% of obstetric providers serve rural communities.

  The disparities also fall along racial lines. In 2020, more than a quarter of Native American babies and one in six black babies were born in areas with limited or no maternity care. To help us understand why this problem is getting worse, I'm joined by Peiyin Hung. She's an Assistant Professor at the University of South Carolina Arnold School of Public Health and an expert in rural health and disparities in care.

  Peiyin, thank you so much for joining us. Now, if I'm an expectant mother in a maternity care desert, what does that mean for my care?

  Peiyin Hung, University of South Carolina: That means there is a stress associated with travel burdens, the psychosocial burdens that we can't — we don't know about all the uncertainties that facing this family birthing families that they may have to travel more than 30 minutes, or even more than one hour away to reach one obstetric provider for any kind of perinatal care.

• Ali Rogin:

  And that puts a lot of burden on her just as she's doing her checkups throughout the course of her pregnancy. I also mentioned that the maternity care deserts have increased by 2% in the last two years, why is this problem getting worse?

• Peiyin Hung:

  Yeah, it's a sad that we see a lot of rural hospitals and small hospitals, they just don't afford operating obstetric units because obstetric services and really maintaining this unit is costly. This is as costly as maintaining an ER and ICU because they have to have anesthesiologist call for 24/7, have this designated labor and delivery bed to really care for mothers and brought in people in need.

• Ali Rogin:

  And why is it that the racial disparities in maternity care continue to be so stark?

• Peiyin Hung:

  Yeah, in our research, we found that hospitals — rural hospitals, they are much more likely to close their obstetric units when they are living — they are located in communities that have higher proportion of African American reproductive age women. And this is kind of associated with the — of heavy reliance of Medicaid insurance, we know Medicaid paid about half of on average private insurance. And on top of this, there are different kinds of more practice premiums and all those that add to the financial distress facing rural and small hospitals to really maintain this costly and unprofitable optometric services.

• Ali Rogin:

  Now, this study didn't really look at reproductive care. But there is a body of data that shows that states that restrict access to abortion and other types of reproductive care also tend to provide fewer maternal care services, help us understand the discrepancy there?

• Peiyin Hung:

  Yeah, we know a lot of communities that really have lack of infrastructures of all kind, providers applications, they will gravitate to other states they have relatively less restrictions. And this will kind of worsen the searchers facing a lot of states. They already have higher proportion of communities with maternity care deserts.

• Ali Rogin:

  Peiyin, in the time we have left, I know you've spent a lot of time thinking about how to solve these problems. What do you see as the major solutions?

• Peiyin Hung:

  My team has been really thinking about how to resolve this. We kind of started thinking about, all right, so we have to relearn to the existing resources in each community. Communities are very different. It's not like dichotomous or been a rural, each community, they have different existing resources. And, for example, telehealth and telemedicine represents promising opportunities to really address this kind of gap. So, but then a lot of communities, millions of households do not really have broadband subscriptions, millions of households, they don't really have smartphones, tablets, or even computers to be amenable to Health Medicine, telehealth services.

  So, in this case, we're really targeting different communities with different interventions. And for example, for communities that do have had a risk of high maternal, morbidity mortality, and they do have adequate digital access to telehealth. And we should really leverage telehealth services for those local women and protect people. So, each community should have catered interventions. And that's what we're trying to do and that's for the federal and state efforts have been really highlighting and emphasizing.

• Ali Rogin:

  Peiyin Hung with the University of South Carolina's Arnold School of Public Health, thank you so much for your time.

• Peiyin Hung:

  Thank you, Ali for having me.