Maternity Deserts: The Growing Concern of America’s Maternal Care

It has been about six months since I last reported on the growing concern of maternal care, and in particular, the known issues of maternal mortality rates among African-American women.

A couple of weeks ago, Timothy Powell reported on the Centers for Medicare & Medicaid Services (CMS) “birthing-friendly” designation icon. However, is an icon really enough? The responsibility still seems to lie heavily on the provider’s side, and I am concerned that we have not seen the depths of our maternal health crisis just yet.

Last week, yet another maternity ward, this time in Monroe, Alabama, closed its doors after many last-ditch efforts to preserve a much-needed but severely underfunded resource. In Monroe, where the population grapples with a 22-percent poverty rate, residents now face the expectation of traveling beyond county lines to neighboring hospitals for labor and delivery services. The travel is expected to be anywhere from 35 to 103 miles, each way. This closure marks the third maternity unit that has closed its doors this year in Alabama because of financial constraints and limited availability of willing providers to practice in the state, because of its strict anti-abortion guidelines. Physicians are not willing to take the risk and the

hospitals cannot survive otherwise, to provide the much-needed care for their communities.

In October 2022, the U.S. Government Accountability Office (GAO) released a report on maternal health, urging for governmental support and intervention in the growing decline of obstetric services in rural areas since 2014; over half of all U.S. counties no longer had hospitals with labor and delivery services, as of 2018.

Today is it is estimated that more than 2 million women of childbearing age live in maternity care deserts, meaning they reside in counties that do not have obstetric care, many of them rural. In 2022, it was reported that 13 labor and delivery units closed, and unfortunately, this number continues to grow. In California alone, 11 maternity wards have closed in 2023, with only one maternity ward opening.

Maternity care deserts have been associated with a lack of adequate prenatal care, limited to no treatment for pregnancy complications, and increased risk of maternal death.

The top reason for the closures is money, as Medicaid funds about 50 percent of all births nationally, and more than half of births in rural areas.

The second reason is a national shift in declining birth rates.

The third stems from the unintended consequences of more stringent abortion laws, which have put many obstetric providers in a difficult position regarding adherence to nationally recognized care guidelines and state mandates when prenatal complications arise.

In review of CMS maternity initiatives, the focus appears to be on provider quality initiatives, rather than funding support. The only alternative efforts to combating maternity deserts appear to be the growing availability of telehealth to support prenatal care needs and the expansion and support for midwifery services.