by Liz Carey, The Daily Yonder
December 30, 2024
According to new research published in the Journal of the American Medical Association, the number of obstetric units across the country is falling. Without them, the health and life of rural mothers and infants is in danger, said Katy Kozhimannil, lead author for the study and a professor at the University of Minnesota School of Public Health.
“Just because the obstetrics units close, doesn’t mean those communities stop having babies,” Kozhimannil said in an interview with the Daily Yonder. “It just means they have to go farther and face more challenges in having a successful delivery.”
The research found that maternal mortality rates in the U.S. are consistently higher than those of other high-income countries, and that maternal mortality rates are higher for people in rural areas as well as for people of color.
In 2021, the rate in the United States was 32.9 deaths per 100,000 live births, while other countries such as Australia, Austria, Israel, Japan, and Spain had rates between 2 and 3 deaths per 100,000 live births, according to the Centers for Disease Control and Prevention.
Closures of hospital obstetric units further impacts the situation, the study found.
The study, conducted by researchers in Minnesota, Boston, and Philadelphia looked at the changes in access to obstetric care in U.S. hospitals. Using data from the American Hospital Association’s Annual Survey and from the Centers for Medicare & Medicaid Services, the study tracked changes in obstetric status at 4,964 acute-care hospitals, including 1,982 hospitals in rural counties.
Between 2010 and 2022, 52% of rural hospitals lacked obstetric services, compared to 36% of urban hospitals, the researchers found. Overall, 238 rural hospitals discontinued obstetric care, compared to 299 in urban areas. Only 138 hospitals across the country added obstetric services. Of those, only 26 were located in rural counties.
The loss of obstetrics services means rural residents face more dangerous situations when it comes to child birth, Kozhimannil said.
“When a rural community loses obstetric services, it means more births outside of hospitals and in emergency rooms,” she said.
Rural mothers have to drive longer distances to get to a hospital that provides obstetrics services, scheduling a C-section, or giving birth in an emergency room where births are not a specialty, she said.
“When a hospital decides the risk is too high to continue offering obstetric services in that community, the risk doesn’t go away. The risk stays in the community even if it goes away for the hospital,” she said. “People will continue to have babies. Hospitals will make their decisions, but that is not the story’s end.”
It also affects the health of the mother after giving birth, and the health of the newborn.
“Maternal mortality is a tragedy for too many families, and the consequences reverberate for generations. Closure of obstetric units and further limiting access to quality health care is only going to make the problem worse,” Kozhimannil said. “Without targeted resources and policy interventions focused on equitable access to maternity care for all, including people of color and geographically-isolated folks, this public health crisis will only get worse.”
While many apply the term “maternity care deserts” to areas with no obstetrics services, Kozhimannil said that term is misleading.
“A desert is a naturally occurring phenomenon. A place without certain medical services is not naturally made,” she said. “Using that term obscures the deliberate decisions that were made to take those services away from a community.”
Kozhimannil said the time period of the study was a decade during which a tremendous amount of time and attention was given to maternal health. However, between those 12 years, the country experienced a net loss in hospital-based obstetric care, in both rural and urban settings. Maternal mortality has more than doubled and women face more risk than ever, she said.
That doesn’t bode well for the future, she said.
“We’re more than a decade into a severe maternity care crisis and we are still seeing obstetrics units close,” she said. “Unless things change, I think access will continue to decline and we will need to stop being surprised at the results.”
Recent legislation, like the Rural Obstetric Readiness Act, and the Keep Obstetrics Local Act could help turn the tide, she said.
Introduced earlier this year by U.S. Representative Robin Kelly (D-Illinois) and U.S. Representative Young Kim, (R-California), co-chairs of the Maternity Care Caucus, along with Dan Meuser (R-Pennsylvania) and Kim Schrier (D-Washington), the Rural Obstetric Readiness Act would direct the Health Resources and Services Administration’s Alliance for Innovation on Maternal Health to create an obstetric emergency training program for rural health care facilities, as well as establish federal grants for rural health care facilities to purchase obstetrics equipment, and direct the U.S. Department of Health and Human Services to study maternity ward closures.
“One’s ZIP code should not determine one’s access to health care. Unfortunately, many women in rural areas face additional hurdles to receive maternal health care,” Kim, the sponsor from California, said in a statement. “The Rural Obstetrics Readiness Act aims to bridge this alarming gap in maternal health care and provide the workforce, training, and equipment to meet patients’ unique needs regardless of where they live.”
That bill was read twice on the House floor and referred to the House Committee on Health, Education, Labor and Pensions.
The Keeping Obstetrics Local Act was introduced by U.S. Senator Ron Wyden (D-Oregon) this year and would enhance federal support for rural and safety net hospitals providing maternity, labor and delivery services.
“Too many rural communities have become maternity deserts, leaving families without access to care. It’s time we reverse this trend and offer some stability to rural hospitals so they can keep their labor and delivery ward doors open,” Wyden said in a statement when the bill was released. “This legislation will give rural hospitals the means to continue serving their communities, and ensures that large hospital chains can’t exploit the funds for profit.”
In September, that bill was read twice in the Senate and referred to the Committee on Finance.
This article first appeared on The Daily Yonder and is republished here under a Creative Commons license.
