Maternal Health: A Growing Concern in Rural Health

 Distance from qualified care can literally mean life or death for a pregnant woman living in a rural area.

EDITOR’S NOTE: Leslie Marsh reported this story during a recent episode of Monitor Mondays. The following is an edited transcript of her reporting.

While rural healthcare is grappling with increasing financial and regulatory pressures that have led to 120 rural hospital closures over the past decade, it is also dealing with the creation and expansion of obstetrics deserts, as more providers retreat from providing obstetrical services. 

Technology, information gains, and improved practice have led to gains in overall quality of life and longevity for the country at large. Maternal care is a devastating exception to this trend. The Centers for Disease Control and Prevention (CDC) begin collecting data on pregnancy-related deaths in 1986. During the 20^th century, maternal mortality rates declined significantly; however, these rates have been steadily increasing since 1987, from a rate of 7.2 deaths per 100,000 live births back then to 16.9 deaths per 100,000 live births in 2016. If you are a black, non-Hispanic woman, the data indicates that you have roughly three times the average risk of maternal mortality. 

Childbirth is the most common reason for hospitalizations; however, rural hospitals are increasingly electing to discontinue these services. Access to maternity care is of particular concern because roughly 18 million women of reproductive age live in rural areas. A report from the University of Minnesota’s rural research team indicates that mothers who live in rural areas are 9 percent more likely to die or nearly die in childbirth, compared to their urban counterparts.   

A study published in the Journal of the American Medical Association (AMA) indicated that between 2004 and 2014, a total of 179 rural counties lost hospital-based obstetric services. By 2014, a Health Affairs study noted, more than half of all rural counties had no hospital that offered maternity care. Although these hospitals are closing down their obstetrical units, the hospitals still deliver babies, but these deliveries occur in an emergency room, with less-prepared providers. 

The lack of access to high-quality care and obstetrical services close to home is an alarming trend that is putting rural moms at greater risk. Climate and geography can lead to disastrous results for mom and baby. Hemorrhage is a risk even in the hospital setting; it becomes a death sentence if you are 30 miles away from a hospital. 

The data and implications for young women of child-bearing age are troubling; however, the national attention this situation is receiving has led to efforts to reduce maternal mortality, and to find solutions for both practitioners and women giving birth in rural communities without hospital-based obstetrical services. Legislators are paying attention, too – the Rural Maternal and Obstetrical Modernization of Services Act (Rural MOMs Act) would offer grants to train physicians and fellows to practice obstetrics in rural communities; it would also expand the use of telehealth services.  

Identifying the problem and the underlying causes is the first step in finding solutions. All moms should have access to high-quality maternal care, regardless of where they live. Incorporating best practices for maternal care, pregnancy-related complications, and sufficient training are essential next steps. Working together, we can and will do better – our nation’s moms and babies deserve the best care, regardless of their ZIP code. Access to quality obstetric care is a matter of life and death.