A new report from the March of Dimes says that 5.8 million women currently live in counties without full access to maternity care.
The non-profit organization founded by former President Franklin D. Roosevelt says 1 in 3 U.S. counties remains a maternity care desert, which is defined as an area with no hospitals or birth centers that offer obstetric care, and no practicing obstetric clinicians like doctors or midwives.
“Maternity care deserts are not naturally occurring, nor are they inevitable. They are the result of policy decisions and longstanding underinvestment in maternity care infrastructure,” the report entitled “Nowhere to Go” says.
“Individuals in these communities are increasingly required to navigate pregnancy and childbirth with fewer local resources and greater travel burdens,” it adds.
Expecting moms in rural or under-served areas are more likely to face the consequences of maternity care deserts while conditions impact nearly 370,000 births annually, per the report.
The March of Dimes found that 35.9 percent of U.S. counties don’t have a practicing obstetrician clinician.
More than half, or 57.9 percent of rural counties don’t have access to an obstetrician clinician compared to 19.4 percent of urban counties.
The report says workforce shortages are driving the disparity.
“Recruiting and retaining clinicians in rural areas is further challenged by professional isolation, heavy workloads, frequent on-call demands, and family considerations including limited employment opportunities for spouses, housing availability, and long travel distances,” the report says.
“Evidence suggests that medical students who complete rural training are more likely to practice in those settings, especially if they come from rural backgrounds. Strengthening rural training pipelines and recruitment is critical to addressing long-term workforce shortages. Additional strategies include expanding rural training programs, offering loan repayment incentives, and leveraging telehealth to support collaboration and complex care management,” it adds.
Solving the lapse in care could help the U.S. rebound from its status as a country with the highest maternal and infant mortality rates, as well as the lowest overall life expectancy, among comparable high-income, developed peer nations.
The March of Dimes says expanding the workforce is key, noting that 16 states have already expanded midwifery practice, including independent practice, prescribing authority, admitting privileges and pay parity for CNMs.
Comparatively, 26 states and D.C. now allow doulas to enroll as Medicaid providers and bill Medicaid independently.
The report says opening more birthing centers, ensuring expecting mothers are insured and access to reimbursement programs could solve the maternal care crisis in the U.S.
“Traditionally, healthcare providers in the U.S. have been reimbursed through a fee-for-service (FFS) model, in which payment is tied to each individual service delivered. In contrast, value-based payment (VBP) models incentivize high-quality, coordinated, and cost-efficient care. Efforts to expand VBP in maternity care include pay-for-performance models, episode-based bundles, maternity care homes, population-based models, and total cost of care approaches,” the report says.
“Strengthening and scaling value-based maternity care models may improve access, quality, and cost-efficiency. Some value based models also create opportunities to better integrate midwives, doulas, care coordination, and postpartum support into maternity care systems,” it continues.”
