March: Maternity Care Deserts in Rural Communities
Written by Esmeralda Abreu Jerez & Sophia Perez
POint of View:
The Life-Threatening Consequences of Rural “Maternity-Care Deserts”
Western North Carolina is a maternity care desert where the counties without a labor and delivery unit are all classified as rural areas. As defined by the article, a maternity care desert is an area with “no hospitals providing obstetric care, no birth centers, no OB-GYN, and no certified nurse midwives.” We are first introduced to Katlyn Moss, an OB-GYN nurse forced to travel 107 miles in the snow to give birth to her second child. Though she had given birth to her first child at Angel Medical Center, only 40 miles from the neighboring county, the medical center closed in 2017. Unfortunately, this problem is not singular. Four labor and delivery units have closed, and five counties in Western North Carolina have lost OB-GYNs since 2015.
Furthermore, new OBGYNs are not arriving in the area, and out of the nine residency programs for aspiring OB-GYNs in the state, none are in rural areas. Compounding the issue of maternity care deserts, the high mortality rates for Black women and frequent dismissal of their health concerns worsen the health outcomes for pregnant people of color in these deserts. Bringing in Moss’ lived experience as a nurse, the article poignantly articulates how this lack of maternal care only serves to treat pregnant people like an afterthought as they navigate a healthcare system that devalues them.
Resource:
Rural Maternal Health Toolkit
This toolkit is geared towards healthcare providers to create and implement a maternal program in rural areas. The resource is divided into seven modules, each focusing on different stages of creating a new healthcare program. Accessible to all, it clearly defines the unique issues associated with rural maternal care and highlights the intersectional issues pregnant people encounter in these areas. However, it can also be used by pregnant people in the rural maternity care deserts as the toolkit includes a list of successful rural maternal care programs. Two outstanding examples are Pacify, a 24/7 lactation support app, and Good Beginnings of Central Vermont, a post-partum home visitor program in Vermont.
News Story:
How The Closing Of Small, Rural Hospitals Is Contributing To A Bigger Maternal Health Crisis | Sharon Hospital maternity services must stay open, state rules
Following the story of the maternity ward in Sharon Hospital in rural Connecticut, these two stories highlight people’s fight to keep the hospital’s maternity care ward open. Describing her emergency C-Section, Rachel Tuberville recounts the life-or-death situation she faced. She explains how the proximity of Sharon Hospital to her home was the deciding factor in her and her son, Colin’s, survival. Dr. Howard Mortman, an OB-GYN at Sharon Hospital who was part of Rachel’s care team, describes that in emergency maternity situations, “time is of the essence.” However, despite this need, the owner of the hospital, Nuvance Health, submitted a proposal to close its maternity to the state in 2022, citing financial burdens and low patient volume. According to Alecia McGregor, a Harvard Chan School of Public Health faculty member, this is common as these are low-income areas with few patients, driving hospital owners away. Luckily, the Connecticut Office of Health Strategy denied Nuvance Health’s request, deciding to keep the maternity ward open in February 2024 as Nuvance failed to prove how this would improve healthcare delivery in the region.
Scientific Publication:
Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana
When an area does not have proper healthcare, its people can suffer catastrophically. As maternal mortality continues to rise in the United States, rural inequities only grow, creating life-or-death situations for rural families. Hospitals in rural areas close their doors or move to more profitable areas, and pregnant women are forced to travel long distances for care or, sometimes, go without prenatal care. These trends aggravate the already-stark disparities for rural mothers.
Geocoding of maternal deaths in Louisiana showed that living in a maternity care desert was associated with a staggering 91% increase in risk of death during pregnancy or in the year following birth. Living in a maternity care desert was also associated with a threefold risk of dying directly from pregnancy. Without prenatal or emergency care nearby, physical health suffers, and so do other health measures: obstetric care provides a rare and critical opportunity to screen for intimate partner violence, mental health issues, or substance use. It allows healthcare providers to educate expecting parents on health behaviors like infant sleep practices or how to use a car seat. All these uses of obstetric care address and prevent death.
These findings show a need for resource sharing across hospital systems, support for women who need to travel for care, and increased access to care during pregnancy.
