Declining birthrates are forcing some hospitals to close their maternity wards, The Wall Street Journal reported Thursday, reigniting concerns that some mothers and babies in rural communities can’t access pre-and neo-natal care.
Expanding “maternity care deserts,” described by the nonprofit March of Dimes as counties with no hospital maternity services, birthing centers or qualified caregivers — including obstetricians, gynecologists, and certified midwives — have concerned experts for years.
Between 2018 and 2022, access to obstetricians and hospital maternity services decreased in 83 and 48 counties, respectively, while only 78 counties’ access to obstetricians and nine counties’ access to maternity services increased.
As a result of increased closures, March of Dimes classified 1,119 counties as maternity care deserts in a 2022 report, a 2% increase from 2020 impacting more than 2.2 million women and 147,000 births.
Rural hospitals — including maternity wards — and other healthcare facilities often struggle to remain profitable in unpopulated areas. This means they generally lack equipment and specialized doctors, including cardiologists and anesthesiologists, which, in turn, makes it hard for functioning maternity wards to recruit and pay qualified staff. But as national birthrates continue to decline, maternity wards themselves are closing.
The confluence of these factors creates a troubling scenario for prospective mothers. When maternity wards close, obstetricians and other qualified caregivers leave to find better job opportunities. The remaining hospital staff, some of whom have never delivered babies, must oversee perinatal, labor and delivery care, potentially delaying the diagnosis and treatment of serious conditions like preeclampsia and amniotic fluid embolisms. Pre-existing conditions like obesity and hypertension, which occur at higher rates in rural areas, further exacerbate the occurrence and danger of pregnancy complications.
Some rural hospitals lacking the equipment and experience to treat mothers or newborns in medical crisis must transport patients to a better-equipped hospital. The longer the journey between hospitals, the less effective most life-saving treatments will be.
What’s more, women in rural areas are more likely to have Medicaid — or no insurance — than private insurance providers, which can further limit mothers’ treatment options.
It’s perhaps no wonder, then, that giving birth in rural areas is distinctly more dangerous than in cities. In 2015, pregnancy-related complications killed women in rural areas at a 64% higher rate than women in large cities, according to the Journal’s analysis of CDC data.
Maternity wards likely won’t reopen in rural areas while birthrates remain low, but implementing some cost-effective solutions can mitigate the damage of maternity deserts.
Telehealth medical consultations could help women in remote locations have successful pregnancies — but only if the community has broadband internet. Midwives and birthing centers, while not having the full capabilities of a maternity ward to perform caesarean sections or treat serious complications like excessive bleeding, provide basic medical care and birthing assistance to mothers at a cheaper rate than hospitals, and certified doulas, which provide guidance and support to mothers throughout the pregnancy process, are a cost-effective way to spread information about healthy pregnancies.
These stop-gap measures might alleviate some harms, but they don’t address the root of maternity care deserts — falling birthrates.
Some critics argue that increased government funding for maternity wards will fix maternity care deserts — but this assumes that the government can back enough maternity wards to provide exceptional care across the United States. This is not a reasonable expectation.
Cheap, efficient services are best provided by private entities. The American people have effectively communicated that giving birth is no longer a priority, which makes maternity care an unprofitable investment for medical providers. When birthrates rise, providers would have monetary incentive to provide more maternity care nationwide.
The solution to maternity deserts — and innumerable other societal ills — is more children. Communities face problems when leaders assume that fewer babies are better.
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