Half of the rural counties in the United States no longer have maternity wards at their hospitals, and thousands of women do not have access to local prenatal care. Absent local physicians, many of these women will go into labor at home, or in an understaffed hospital. That means riskier deliveries, pre-scheduled C-sections, and more maternal and infant deaths.
“Most of the rural hospitals around us, at one time or another, delivered babies over the last eight to nine years,” Alan Kent, CEO of Meadows Regional Medical Center in rural Georgia, told The Washington Post. But in recent years “two hospitals have closed. The three remaining hospitals that had maternity wards ceased their women’s services and stopped delivering babies.”
“We’re seeing an increase in women who deliver with no prenatal care.”
It’s a problem that epidemiologists have been tracking for some time. Barely five percent of obstetricians and gynecologists work in rural America, where 15 percent of the U.S. population happens to live. The result is that fewer than half of rural women live within a 30-minute drive of a maternity ward. Twelve percent live more than an hour from the closest OB-GYN. A recent study found that between 2004 and 2014, one in 10 rural counties lost their maternity wards. The result is 2.4 million women of childbearing age left without essential medical services.
Alabama has 54 rural counties, but only 16 currently offer obstetrics services (45 had maternity wards as of 1980). North Carolina is now also seeing a dip in rural OB-GYNs, with the closing of several labor and delivery centers managed by the Mission Health hospital network. The result is that women in these areas disproportionately schedule C-sections so that they won’t go into labor without enough time to make it to the hospital. Meanwhile, maternal and infant mortality seems to be significantly higher in these rural areas. Scientific American ran the numbers and found that the maternal mortality rate in metropolitan areas was 18.2 per 100,000 live births, but nearly double that figure in rural areas. Ditto for infant mortality rates.
Part of the problem is that staffing a maternity ward at all hours for a small population that seldom needs it is a logistical nightmare, The Carolina Public Press reports. It’s also not a very lucrative one, given that more than half of births are funded by Medicaid and whatever dividends remain are often swept up by malpractice premiums, which are especially high for family physicians and smaller hospitals that offer obstetrics services.
“Hospitals that have the fewest births have to pay the highest premiums because the risk level is higher when something happens less frequently,” Katy Kozhimannil of the University of Minnesota told The Carolina Public Press. “This is all from conversations with folks … it’s not something we’ve looked at in research, but it is something that comes up in conversation with clinicians, and with hospitals.”
Unfortunately, solutions are not forthcoming. One barrier is that federal physician shortage programs — which pay for medical school on the condition that a medical student commits to practicing medicine in an underserved community — aren’t tailored to the needs of specific communities. “Right now, an underserved community might have no pediatricians but several obstetricians,” The Washington Post explains. Legislation to fix that is currently in progress.