This is a statistic that may take a second to sink in: New research found that 45% of all rural counties in the US had no hospital-based obstetric services during the 10-year period they were studied. 45 percent. That means that almost half of rural counties had no hospital obstetric service anywhere in the country. Not only is it shocking, the research—from the Rural Health Research Center at the University of Minnesota—may shed light onto recent findings that women in the US have the highest maternal death rates of any developed country. We are not providing maternal care for women—and they’re dying because of it.
Now, to put this in perspective, childbirth is the most common cause of hospitalization in the country. Yet, we’re simply not providing the services to hospitalize in certain areas. The research found that almost 2 million women of reproductive age lived in the rural counties studied. That’s a shocking amount of women without access to what, in many other countries, would be considered a basic necessity of medical care. This isn’t even about cost or access—it's about the fact that they don’t even exist.
And the problem isn’t getting better—in fact, it’s getting worse. The same research found that, in the 10 years they studied, 9% of counties lost their services. How, in the 21st century, are we removing basic healthcare for pregnant women and mothers, rather than increasing it? There are a host of factors, but none of them really explain how it’s gotten so bad.
A huge part of the issue seems to be cyclical—when there are too few maternal services, it puts a huge amount of pressure on practices that do offer them, so those practices, in turn, may drop obstetric services if they’re feeling overwhelmed. “Right now we’re in a downward spiral,” Dr. Adrienne Zertuche, an OB/GYN and the president of Georgia Maternal and Infant Health Research Group, told Atlanta magazine. “If you practice in a small town where there were once three or four physicians, that’s not terrible if all of them are taking OB calls. But if one retires or moves away, and there’s no way to replace them, the remaining physicians take on a greater burden. And if one of those is a mom of three with lots of family demands, she might drop out, too. And then maternity care in that town has just self-destructed.” It’s far too common. For women affected, especially black women and Medicaid beneficiaries in these rural areas, they’re losing vital services. Driving hours for medical attention—or to deliver your baby—is simply not acceptable, but it is happening, because there are too few services and they just can’t cope.
There are a few different angles from which the issue needs to be tackled. One suggestion is that greater access to Medicaid coverage during pregnancy could make it more financially viable to provide services in rural areas. Another is making it more desirable to practitioners—both the rural locations and the practice of obstetrics. “There have been some successes. In 2014 the Georgia House of Representatives passed a bill to make it easier for OBs to qualify for tuition reimbursement so long as they practice in areas of need,” Atlanta magazine reports. “If eligible, they can receive up to $25,000 in annual loan repayment for up to four years. The state has also tried increasing its funding for OB/GYN residency slots.” There’s hope that attracting new doctors can break the cycle of over-burdening and provide more services to women in these areas and it needs to happen fast. It can be traumatizing to need to travel these distances during some of the most stressful periods of your life. And for some women, it’s deadly.
Change may be coming in some places, but for millions of women living in rural areas, they can’t wait that long. It’s an embarrassment that this is happening in our country and that, if you’re already in the vulnerable position of being pregnant and far away from care, the onus is on you to come up with a solution.
So remember, planning is key. "Labor and delivery involves many uncertainties," Peiyin Hung, a postdoctoral associate at Yale School of Public Health and lead author of the study, told Broadly. "Patients' needs in obstetrics may change rapidly and without warning, leaving rural women without immediate access to needed care. The farther a hospital-based obstetric care is from home, the more planning measures are needed for a rural family. Previous studies have showed psychological burdens from traveling for childbirths." So make sure that you know where you care is located, how to get there, and make any practical planning you can in advance.
If you’re lucky enough to have good insurance and live in an area with easy access to healthcare, it’s difficult to imagine what it would be like to be miles away from the nearest doctor to help you during a dangerous and difficult time. The fact that services are closing, rather than spreading, in the 21st century should cause a moment of self-reflection for our country.