Vania Biglefthand, a mom in rural Montana, lives a two-hour drive from the closest maternity care center in her area. “Traveling for maternity care was exhausting at times,” she says. “I had to request time off or rearrange our schedules to make it to our appointments, and since I had two older children, I had to make sure we were back in time for one of use to pick them up when school ended.” Getting care was more of an inconvenience at first, but when Vania’s water broke early, it became an emergency. Fortunately, she arrived on time to stop her labor. “If I had gotten there any later, there was a high possibility that I would either deliver the baby at 30 weeks premature or lose the baby,” she says.
What Is a Maternity Care Desert?
Maternity care deserts are defined as counties without a hospital or birth center offering obstetric care and without any obstetric providers. According to the March of Dimes report, 1,119 counties have no maternity care and nearly 7 million women of childbearing age live in either a maternity care desert or an area with limited access to care. These numbers are up 2% since their 2020 report. “Of the counties that worsened between this report and the last report, half of them were attributed to loss of obstetrics providers, and over a third were attributed to hospital and maternity care unit closures,” says Stacey D. Stewart, the president and CEO of March of Dimes. “Living in areas with no or limited access to maternity care is putting these moms and babies at risk of serious health complications.”
Who’s Most Affected By a Lack of Pregnancy Care?
Families in rural areas like Vania’s, low-income families, and people of color are most affected by a lack of access to prenatal and birthing care. “One measure of lack of maternity care access is the proximity to hospital obstetric services,” says Stewart. “Half of the women who live in rural communities must travel greater than 30 minutes to reach an obstetric hospital, as compared to seven percent of women in urban areas.” Susan Lipinski, MD, an OB/GYN at Obstetrix of Colorado cares for patients who live in rural areas. She says many patients cannot afford to miss work for the length of time it takes them to get to and from their appointments. Rural patients with high-risk pregnancies may have to travel even farther. “We have patients who have come to our practice from remote mountain towns that are anywhere from four to eight hours away,” she says. “If they need emergent care, they have to be transported by helicopter or even by plane. Many have to stay locally for weeks and even months until they deliver so that they can get the care they need.” The March of Dimes report found Native American families were most affected, with about a fourth of these babies being born in areas with no or limited access to maternity care. Black families were also disproportionately affected, with one in six Black babies being born in areas with no or limited access to maternity care services. Black women are also three times more likely to die during pregnancy than White women. Hispanic, Asian and Pacific Islander women were also less likely to receive adequate prenatal care when compared to White women. Care in Ohio dropped most significantly since the 2020 report, while Florida saw the greatest increase in care.
Risks of Living in a Maternity Care Desert
Accessible, quality care is essential for a birthing person’s health as well as their baby’s. Living in an area without this access can increase the chance of complications, such as low birth weight, preterm birth, or even stillbirth. Birthing parents who do not receive prenatal care are three to four times more likely to have a pregnancy-related death than women who receive prenatal care. “Patients with complications such as placenta previa can have bleeding at any time during the pregnancy that can become life-threatening to both mom and baby,” says Dr. Lipinski. “The farther away the patient is from a hospital capable of handling, the higher the chance of maternal and fetal mortality.” When Vania’s water broke early, she needed immediate care. Instead, she had to make a two-hour drive in the middle of the night. “Not only had my water broken and my amniotic sac fluid was dangerously low, but I was also in labor,” she says. She was required to stay at the hospital on bed rest for the duration of her pregnancy and once her baby was born, she spent 16 days in the Newborn Intensive Care Unit (NICU). Throughout her stay, Vania’s husband and two older children made the long drive back and forth every other day to visit her.
What Should I Do If I Live In a Maternity Care Desert?
If you live in a maternity care desert, there are options to get the care that you need. You may be able to find a general physician that practices family medicine, access a local health care clinic or urgent care, or search for a Federally Qualified Health Center. Federally Qualified Health Centers are often located in underserved areas, offer sliding pay scales, and offer comprehensive services. March of Dimes may also be able to help. The organization provides in-person and virtual resources and programs such as group prenatal care and NICU support programs for families whose babies need to stay in the hospital. A March of Dimes advocate worked with Vania while she was hospitalized to make sure she was comfortable and got the information she needed. The advocate also helped her connect with other NICU families going through similar experiences. March of Dimes also offers Mom and Baby Mobile Health Centers in Southeast Ohio, Arizona, and the Washington, D.C. area. “Last year, our Mobile Health Centers provided 2,400 patient visits in five communities across the country,” says Stewart. “They helped uninsured and under-insured women of childbearing age receive quality health care for themselves and their babies.” They will be adding a mobile health unit in New York City later this year.
How to Improve Pregnancy Care
Quality pregnancy care improves outcomes for birthing parents and their babies, yet not everyone has access to this care. Some states have expanded Medicaid, which has helped to improve pregnancy care. “Hopefully more states will follow suit,” says Dr. Lipinski. “Lack of insurance is a major impediment to obstetrics care both in rural and urban areas.” Telemedicine has increased in recent years, especially since the COVID-19 pandemic began. Continuing to build these types of programs may help patients access specialists in rural areas where they are not available. Dr. Lipinski says providing incentives for healthcare team members such as nurses, physicians, and midwives to work in rural areas may also help increase qualified staff in rural hospitals. “Most states have programs that provide loan repayment for working in rural areas, but most of these programs are for primary care and exclude OB/GYNs,” she notes. The increase in maternity care deserts over the past two years has been in part due to the closures of small critical access units. Dr. Lipinski suggests financial incentives through Medicaid to help keep low-volume labor and delivery units open and more rural residency training programs in obstetrics to help fill the many open positions. March of Dimes has also launched a campaign to improve prenatal care called the Mamagenda. The Mamagenda calls for affordable health insurance, housing assistance, and programs that give families access to nutritional food and public transportation. These are the building blocks to help families get the care they need. March of Dimes is pushing for more programs that offer maternity care throughout the country. To increase the number of quality providers, they call for certified nurse-midwives to have expanded practice authority. They are pushing for more newborn screening programs to make sure babies get the care they need. Anti-bias training for health care professionals is also recommended to reduce the disparity in birth-related deaths among Black people.
