Maternity Care Deserts

By Lucy Li, University of Washington Information School Capstone Student

In a report to Congressional Committees addressing maternity care in rural America, the Government Accountability Office (GAO) found more than half of rural counties in the U.S. did not have obstetric services as of 2018. Most affected counties were those sparsely populated, African American communities, and areas of low income. Many studies have found that long travel distances to obstetric and prenatal care visits due to local rural hospital maternity unit closures have led to negative health conditions, such as premature births, non-indicated induction and C-sections.

The GAO report also found the two most important factors contributing to rural maternity units decline were 1) Less than fully covered Medicaid reimbursement in rural areas where a higher proportion of births were covered under; and 2) Challenges in recruiting and retaining a full range of maternity providers in competition with urban hospitals. And thus it proposed to increase Medicaid reimbursement, increase remote consultation, and establish regional partnerships. In a similar note, the National Rural Health Association also issued policy suggestions to incentivize rural practitioners’ recruitment and retention and to expand Medicaid eligibility to pregnant women.

Astria Toppenish Hospital in Yakima Valley, Washington closed its Family Maternity Center starting in January 2023. Since then local communities in the Yakama Indian Reservation and Lower Valley have held town hall meetings addressing concerns for women and children’s safety in the region since the closure of the maternity center requires re-directing maternity care to hospitals further away.

The decision to close its maternity center was largely financial, citing a $3.2 million loss in 2022 due to a 50% decrease in deliveries in the past five years, one third loss in Medicaid reimbursement, and the high cost of labor together with labor shortage. The closure is one that reflects the economic situation of many U.S. hospitals, and even more so after the COVID-19 pandemic. But healthcare professionals and local communities are more concerned that those affected most are usually rural and disadvantaged minority populations.

According to the American Hospital Association, rural hospitals represented 35% of the nation’s community hospitals, and they delivered 1 in 10 babies in the U.S. Yet half of these hospitals did not offer obstetric services in 2020. Furthermore, between 2015-2019, there were at least 89 obstetric unit closures in these rural hospitals, leaving 2.2 million childbearing aged women living in “maternity deserts”.

In an NPR news article on the trend of maternity units closures in American rural hospitals, the author cited suggestions of providing scholarships for primary care providers who serve rural communities with encouragement for them to take roots in those communities and to establish less expensive birthing centers using midwives. In February 2023, A UW Medical School study supported one of these two suggestions. The study found that medical students who had served in the Rural and Underserved Opportunities Program were almost twice as likely to eventually set up their practices in rural locations, providing some hope for the future of rural healthcare.

In the meantime, a group of local members has organized a Toppenish Maternity Workgroup that started a petition for the establishment of a public hospital district in the Lower Valley and a free-standing birthing center as alternatives to provide services for its local residents in the aftermath of the Family Maternity Center being closed in the local hospital. More research and advocacy, however, are needed in stopping the trend of maternity unit closures in rural hospitals and the desertification of maternity care for rural communities.