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The Center for Health Journalism at USC Annenberg hosted a recent discussion on maternity care deserts in America. During “Dangerous Deliveries: The Spread of America’s Maternity Care Deserts,” two distinguished journalists—past fellows at the USC program—talked about their extensive research and reporting on the communities most affected by the growing crisis in maternal care.
Here are our top five takeaways:
1. Maternal health care is vanishing. The March of Dimes defines maternity care deserts as “any county in the United States without a hospital or birth center offering obstetric care and without any obstetric providers. Its 2022 report showed that 36% of U.S. counties fit this definition, a 2% increase from the 2020 report.
Areas with low or no access affect up to 6.9 million women and almost 500,000 births nationwide. Of those maternity care deserts, 61% were rural counties.
👉 Federal Way Birth Center Founded to Combat Discrimination in Maternal and Infant Care
2. Rural communities are particularly vulnerable. About 2 million rural women of childbearing age live in maternity care deserts at least 25 miles away from a labor and delivery unit, a USA TODAY analysis found. About 1 in 9 rural Native women and 1 in 16 rural Latina women are 40 miles or farther from the nearest maternity ward.
“Half of the nation’s rural hospitals have no obstetric or OBGYN practitioner,” said Nada Hassanein, health care reporter for Stateline. “Research has also found rural, Black communities are more likely to lose their obstetric units.”
Hassanein described the experience in Jasper, Florida, of a mother who had to drive about 70 miles round trip every other week for her prenatal appointments and to deliver her baby. A long drive or ambulance ride in the face of a life-threatening complication can prove fatal or lead to complications that traumatically change the course of a young life.
👉 Black Women Fear Death During and Post-Pregnancy
3. There are geographic and systemic problems at play. “Rural communities with larger proportions of people of color, such as Jasper, have been found to be farther away from obstetrics than rural white communities,” Hassanein said, adding, “It’s not just a geographical problem, but also a systemic one.”
Our health care system is decentralized and favors volume. For hospitals in these poorer, rural communities, these two factors don’t often offer sustainable support, since they see lower birth volumes and primarily rely on the low rates of Medicaid reimbursements for service.
4. Policies underpin some of today’s ongoing disparities. In Georgia, nearly half of the state’s predominantly Black counties are now considered maternity care deserts.
“Work to build trust with local mothers and put in the time, approaching them with patience, empathy and sensitivity. Let them know that you want their birthing experiences told, their concerns conveyed and their needs communicated. Be sensitive and gentle, as these experiences often may have been traumatic and taxing.
Additionally, if the community is low-income, which these communities often are according to data, mothers’ time and financial resources may be scarce or strapped, and phone calls will not be sufficient to consistently reach them and build rapport. Go back multiple times and spend time with them.”
– Nada Hassanein, Center for Health Journalism blog
In researching the state’s health care system, Margo Snipe, national health reporter at Capital B News, discovered Certificate of Need regulations uniquely restrictive in Georgia. “The system makes it super hard to open care, but to shut down a facility, all that’s required is a 30-day notice to the state,” Snipe said.
And existing hospitals or health care systems can fight against the appeal. A woman’s efforts to open a birth center in a Black part of Augusta County are blocked. “She had hundreds of letters of support,” Snipe said, “She still hasn’t been able to open it, because hospitals have fought against it.”
👉 Geography and Race, State by State, Can Determine the Fate Of Both Mother and Baby
5. Many communities are taking matters into their own hands, like the folks behind the Augusta birth center, and tribal women, who have to travel some of the farthest distances in the nation to receive care.
Hassanein mentioned some who plan on learning to drive an ambulance and others who volunteer as emergency medical technicians. “A hospital closure has a really wide effect on a community, and that has implications for maternal health, but also just general health in an emergency,” Snipe said.
Early Learning Nation columnist Mark Swartz writes for and about nonprofit organizations. Author of the children's books Werner Herzog Eats His Shoe, Lost Flamingo, Magpie Bridge and The Giant of the Flood as well as a few novels, he lives in Takoma Park, MD, with his wife and two children.
