Maternal Health
The United States has the highest rates of maternal death among high-income countries, three-times higher than comparably wealthy nations. Maternal health disparities impact certain populations more severely than others. For example, the maternal death rate for black women is 49.5 deaths per 100,000 live births, compared to the US average of 22.3 deaths per 100,000.
Rural populations face maternal death disparities too. "Noncore" areas (areas outside metropolitan and micropolitan statistical areas defined by the Census) have a maternal mortality rate of 26.8 deaths per 100,000 live births compared to 19.5 deaths per 100,000 for large central metro areas. Further, the situation for rural women is likely to get worse.
Maternal health access has been declining in recent years. In 2024, the National Rural Health Association shared that 36% of U.S. counties, a majority of which are rural, are maternity care deserts. A maternity care desert is any county without a hospital or birth center offering obstetric services. In 2022, more than half of rural counties (58.8%) had no hospital-based obstetrics unit, up from 51% in 2010.
Katy Backes Kozhimannil, a professor at the University of Minnesota School of Public Health, told The Daily Yonder that closures of obstetric units are due to "not having enough revenue to keep the units open, as well as not having enough births and specialized skills to care for obstetric patients and not having enough trained clinicians to keep the unit operating."
Closure of rural hospitals exacerbates the maternal health crisis in these rural communities. Since 2005, 110 rural hospitals have closed, and almost 800 are currently at risk of closure due to financial distress. A previous blog post discussed the rural "slush fund" included in Trump's "Big Beautiful Bill," which included a $50 billion program to support rural health. The fund, named the Rural Health Transformation Program, is overshadowed by the fact that the bill cuts Medicaid funding by almost $1 trillion, estimated to be $137 billion in rural areas.
A study by Georgetown University Center for Families and Children showed that 47% of children and 18% of adults in rural and small towns rely on Medicaid (numbers that the study predicts underestimate the true values). Also, nearly half of all births in rural hospitals are covered by Medicaid. While the rural "slush fund" may provide some funding for rural health care infrastructure, its only one-third of what rural communities expect to lose from the cuts.
The fund will be distributed over five years, $10 billion each year starting in 2026. The amount each state will receive this year averages $20 million. Half of the fund is distributed equally across states, with only a quarter of the fund being distributed based on need, meaning that states with significantly larger rural populations may receive similar amounts of funding to states with lower rural populations. Additionally, the fund is broadly available to aupport health care systems, with initiatives not directly tied to rural health, such as Make America Healthy Again (MAHA), posted by Centers for Medicare & Medicaid Services (CMS) as an example of what may receive funding.
Abortion Access
On another reproductive healthcare front, access to abortion clinics from rural areas is limited. In California, about 40% of counties do not have an abortion clinic, and most of these counties are rural. In Inyo County, CA, most residents live over 200 miles from the nearest abortion provider. The lack of abortion care is shocking in light of California's support for abortion access. But residing in a state that recognizes the right to abortion does not mean its residents automatically enjoy easy access to abortion providers. Avery Van De Berg previously wrote on this blog about the severely limited abortion access in Missouri, despite their amendment to protect abortion rights.
Rural residents in states that have enacted post-Roe bans on abortion face even greater barriers to care. Many residents now have to travel significantly farther to find abortion providers. Sarah Melotte of The Daily Yonder analyzed abortion care data and found that after Roe was overturned, rural travel to abortion providers increased from 103 miles on average to 159 miles on average. This distance can be significantly farther in some rural areas. Travel to an abortion provider is as far as 800 miles of travel from parts of rural Texas and 492 miles of travel for the average rural Louisiana resident.
What's the Solution?
Policy-makers have proposed solutions to the reproductive health care crisis facing rural residents experience. Similar to solutions posed to prevent legal deserts, a solution for maternity care deserts includes recruiting, training, and retaining physicians who provide maternal care. To improve access to care, Telehealth policies have been proposed to bridge the gap between physicians in rural area and maternal care needs.
Undoubtedly, many of these solutions come down to investment in rural health care. We've yet to see whether laws like the "Big Beautiful Bill" will fulfill promises of affordable and available healthcare in rural communities.
For more academic analysis of these issues read more here and here.
4 comments:
I think it is generally shocking for urban people to realize that putting something into law doesn’t inherently mean that there is access to that resource. It requires a more comprehensive understanding when drafting laws, as there’s so much bias inherent in the way that people think.
The erosion of maternal health care in rural areas is a slow abandonment of entire communities. When hospitals close and OB units close it is not a technocratic mistake. Childbirth is vulnerable and uncertain enough without a multi-hour drive. The planning this must require is itself a source of stress.
The decline of access to reproductive healthcare, particularly abortion care, across rural areas is a crisis more attention needs to be drawn to. As reproductive rights clinics and doctors across the country are vilified for the care they provide, I can't help but wonder how this will negatively impact maternal mortality rates. Along with the legal and policy solutions to this problem, recognizing reproductive healthcare as essential as all other forms of healthcare will bring about a large culture shift that is needed on this topic.
I appreciate the attention that this post draws to the impacts that increased travel distanced for essential services can have. This, like many other conservative policies, seems near intentionally designed to disproportionately affect poor people.
Post a Comment