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Pregnant and No Access to Care: Taking on America’s Maternity Care Deserts

With limited access to maternity care, 7 million women in the U.S. face the reality of having a baby without the necessary support.

This story was produced in partnership with Reckitt’s Enfa portfolio of brands.

For many, the months leading up to childbirth are a whirlwind of planning. There are regular appointments with obstetricians and prenatal care teams to ensure the health of mom and baby. For the first baby, there are often birthing, breastfeeding, nutrition, and parenting classes. There might be sessions with a certified doula to better assist on the day of birth. And of course meetings with fellow parents-to-be to discuss the emotional rollercoaster that is expecting a child.

Whatever the specifics, for many parents in this country, a baby’s delivery is a well-planned event. Now imagine that you didn’t have your trusted OB. Pretend that all those classes are not offered and that there are no doulas available in your region.

Unfortunately, this is the experience of millions of American women who are pregnant without the support of quality prenatal care — or any care at all. So just how did we get here? And how do we get care to all expectant moms in the United States?

How Maternity Care Deserts Came to Be

There are currently 2.2 million women in the U.S. who live in counties with zero access to care during their pregnancy, known as maternity care deserts. That means no hospitals that offer prenatal services, no birth centers, and no obstetricians. Another 4.8 million women live in counties where maternity care options are extremely limited. Together, these 7 million women give birth to 500,000 babies in the U.S. each year – or one in eight newborns – yet because they do not have the same medical support system as women who live closer to hospitals or medical centers with practicing OB/GYNs they face unique challenges in their pregnancies and deliveries.

Many fall victim to the disturbing maternal care situation in the United States. Every 12 hours, a woman dies from pregnancy-related causes. And the maternal mortality rate in America is rising — it is double that of other developed nations including five times that of Germany and four times greater than Sweden.

“Maternity care deserts are part of a national crisis,” says Stacey D. Stewart, President and CEO of March of Dimes, a national nonprofit that works to improve the health of mothers and babies. “Moms and babies need us now more than ever,” Stewart wrote in her introduction to the organization’s bombshell 2020 report, Nowhere to Go: Maternity Care Deserts Across the U.S. “We face an urgent maternal and infant health crisis that has only intensified with the COVID-19 pandemic.”

Mobilizing to help Maternity Care Deserts

Grasping the magnitude of the situation, March of Dimes partnered with Reckitt’s Enfa portfolio of brands to create Better Starts for All, a multi-year initiative aimed at educating and supporting pregnant women in areas of the country where access to care can be improved. The campaign is multi-faceted and includes a digital destination where women can sign up to access provider services along with peer support as well as a boots-on-ground approach with a mobile clinic bus.

The mobile bus is currently active in Washington, D.C., with a second rollout scheduled in southeast Ohio in the upcoming weeks. “Our biggest challenge with southeast Ohio is the immense space it covers,” says Dr. Abra Greenberg, a women’s health nurse who has over 15 years of experience. She joined March of Dimes about a year ago, and eagerly signed up to coordinate the Better Starts for All initiative in Ohio after learning about their mission and feeling compelled to help make a change. “Our mobile bus is in Jackson County, where there is not a single OB/GYN provider in the whole county,” she says. “Women have to drive up to an hour and a half just to get care.”

The goal with the mobile maternity care bus is twofold: First, to give direct medical assistance to pregnant women in the community in the most convenient way possible. (“They are seen by certified nurse-midwives right on the bus,” says Greenberg. “If a woman is considered high risk, we offer a telehealth opportunity so women can get help where they are.”) Second, they aim to provide more comprehensive services that are lacking in rural areas.

“We’re there to help connect them with social workers, Medicaid, food pantries, behavioral and mental health services, and so on,” says Greenberg. “Southeast Ohio has a growing epidemic with substance use disorder and we have resources available for helping them with that too.”

The Better Starts for All mobile clinic in Ohio is a fully operating medical facility, says Greenberg. “It has a central receiving area where people can check in and exchange information, plus two private exam rooms where women are seen by providers,” she says. “We’ll have certified nurse-midwives and medical assistants, four to six staff total who can see women on the bus.”

While the telehealth opportunity will be key for high-risk patients, Greenberg acknowledges that poor wifi capabilities in rural Ohio can make this a challenge. “My calls get dropped four to five times a day out here,” she says. “That’s why this mobile bus is so important.”

The mobile clinic model works well in rural areas where there are literally no practicing obstetricians within miles of many communities. But it also serves a much-needed function in low-income urban settings where the number of hosptials has been dwindling in recent years.

Such is the case in Wards 7 and 8 in Washington, D.C., where certified nurse-midwife Billie Hamilton-Powell serves as Director of Mobile Health and Director of Midwifery Care for the University of Maryland Capital Region Health, partnering with March of Dimes and Better Starts for All to provide mobile health access through the Mama & Baby Bus.

“We’ve had several hospital facilities in these neighborhoods close in the last several years,” she says. “Women have been left without access to maternal health care.” Unlike Ohio’s rural Jackson County, in urban D.C., the challenge is not the distance women need to travel for care but the logistics. “It’s about cost of travel and how to get from your home to across the city to see a provider,” she explains. “There’s no easy way to get there, so are you going to pay for an Uber? And if you only have money for an Uber or for putting food on the table for your family tonight, which are you going to choose?”

Moreover, she points out, for women who already have young children, spending half the day traveling from one side of the city to the other to see a doctor is complicated by what to do with your kids while you’re away from home. “Do you bring them with you? And if so, do you have to pay for their transport, too?” she asks. “Women don’t seek out prenatal care because they are afraid that they can’t afford it.” The bottom line: The less disruptive and more accessible care is, the more likely it is that women will use it.

The Better Starts for All mobile clinics in Hamilton-Powell’s area park in locations that have been scouted for high foot traffic. “We look at things like where do these women usually go? Churches with food banks? Shopping centers? If we locate our buses in places outside their comfort zone, they won’t come,” she says. “We need to meet them where they’re comfortable. We’ve even parked outside apartment complexes.”

The need is clear: Even though the clinics are scheduled to serve eight women a day, Hamilton-Powell says that they may see as many as 12, depending on location, and there are waiting lists for those who want appointments. “The goal is to see as many women as we can, as early in their pregnancy as possible,” she adds. “The sooner we can identify any potential complications, the healthier their pregnancy will be.”

What the Future Holds for Expecting Moms

One of the key programs offered through Better Starts for All is the Becoming a Mom course, a free nine-week session facilitated by a trained health educator that teaches important topics related to pregnancy, and gives expecting mothers the opportunity to ask questions and connect with other expecting families in the area.

“It’s an outlet for learning and sharing,” says Greenberg, who has led these workshops. “There was one woman who was a high-risk pregnancy, and up until the very last month, she wasn’t sure if she could deliver in the local hospital or had to travel two hours to deliver elsewhere. To have that unknown is so incredibly stressful and the group was a chance to be supported by other women who understood her situation.”

Greenberg hopes she can connect pregnant women who come to the mobile clinic to make use of this support program as well. “Our focus is on providing care and wraparound resources to women who don’t know where to get it,” she says. Whether it’s that you are pregnant after a miscarriage, expecting your first baby, or need help with postpartum issues, “we can help you. We will not turn anyone away.”

To learn more about Better Starts for All and to find programs in your area, please visit betterstartsforall.com or follow the organization on Instagram at @betterstarts4all.