US map of maternal mortality

Maternity care deserts, or maternal care deserts, are areas that lack sufficient maternity care resources.[1] The March of Dimes defines a maternity care desert as a county with no hospitals or birth centers that offer obstetric care and without obstetric providers.[2][3] Out of 3143 US counties, 1119 are classified as maternity care deserts, with a total population of around 6 million people who can give birth.[1] People living in maternity care deserts may have to travel longer distances to receive care, which is associated with higher costs and a greater risk of pregnancy complications.[4]

The March of Dimes also classifies counties as having low access to maternal care if the county has one or less hospital offering obstetric care, fewer than 60 obstetric providers per 10,000 births and 10% (or greater) of women have no health insurance.[2] Counties were classified as moderate access if they met the requirements of having low access to maternity care but the % of women with no insurance was less than 10%. A county with full access to maternity care had two or more hospitals with obstetric care facilities and 60 or more obstetric providers per 10,000 births.[2]

Maternity care deserts are associated with high maternal mortality rates.[5][2] Since 2018, there has been a 4% increase in maternity care deserts in the U.S.[2] In the United States, up to 60,000 women a year experience severe maternal morbidity, life-threatening complications as a result of pregnancy, resulting in up to 700 pregnancy-related deaths annually.[6][7] Maternal morbidity displays decades-long racial, geographical, and socioeconomic disparities. The United States is one of two countries worldwide that has reported significantly increased maternal mortality since 2000.[6]

Contributing factors

Race

Race also plays a role in maternal mortality. In 2021, the maternal mortality rate for Black women was 69.9 deaths per 100,000 live births.[8] This is 2.6 times the rate for White women.[2] Approximately 1 in 6 Black infants were born in maternity care deserts and 1 in 4 of Native American babies were born in maternity care deserts.[2] Native American women are 2–3% of the population, and 13% of them gave birth in a maternity care deserts[3]

Rural communities

2 in 3 maternity care deserts are in rural counties.[2] Since 2004, rural communities in America have seen a decrease in obstetric services in hospitals.[9] Between 2004 and 2016 obstetric service's have decreased from 54% to 45%.[10] Rural areas have a higher amount of people on Medicaid and because Medicaid covers less than private insurance for child birth, rural hospitals are unable to support obstetric care fiscally or through necessary staffing.[9] When these care units shut down, the healthcare workers who are able to provide maternity care might leave the area, likely creating a new desert.[9]

Restrictions on abortion services

The overturning of Roe v Wade and changing abortion policy has led to a decrease in access to abortion care across the United States.[11] There is overlap between counties that are classified as maternity care deserts and counties that lack access to abortion services. 3.7 million of women of reproductive age in the U.S. live in both a maternity care desert and somewhere that has no access to abortion services.[12] States and counties with abortion restrictions have fewer maternity care providers with a 32% lower ratio of obstetricians and a 59% lower ratio of certified nurse midwives compared to states with abortion access. This disparity has increased the prevalence of maternity care deserts in recent years.[13]

Texas

46.5% of counties in Texas are maternity care deserts and 4.6% of women in Texas do not have birthing centers within 30 minutes from themselves. In addition, chronic health conditions, like diabetes, can worsen maternal health outcomes. 66% of counties in Texas have high chronic health conditions and preterm births.[2]

Map of Texas counties

14.8% of women in the US who have inadequate prenatal care and 20.4% of women in Texas have inadequate prenatal care. Socioeconomics also impacts prenatal care in Texas. BIPOC women who live in areas with high socioeconomic vulnerability have 44% increased likelihood of inadequate socioeconomic vulnerability compared to areas with low socioeconomic vulnerability.[2]

Recent state measures

  • The Department of Health Services in Texas started the Hear Her campaign to spread education and resources that can help people recognize urgent maternal warning signs and know when they need to seek help. The campaign also encourages doctors and medical providers to listen to women.[14]
  • The United States Health Resources and Services Administration funds the Rural Maternity and Obstetrics Management Strategies (RMOMS) Program that has a Texas organization. The RMOMS provides funds to programs that build networks to coordinate continuum of care and use telehealth and specialty care in areas that need it the most. From 2019 to 2020 the program in Texas served 1,644 women and delivered 1,230 babies.[15]
  • Texas has the Texas Presumptive eligibility program that allows hospitals to determine if individuals need short term Medicaid. Pregnant women can qualify for both prenatal care and care during pregnancy depending on the hospital's approval.[16]

In 2024 there will be a new March of Dimes "Mom & Baby Mobile Health Center" in Houston due to funding from Blue Cross and Blue Shield of Texas.[17]

Policies

The United States government passed policy to reduce infant and maternal mortality through programs like Healthy Start (part of the Children's Health Act of 2000) that funded prenatal care and support for children and mothers thorough early childhood).[9]

Below are polices that could impact maternity care deserts.

Federally funded health centers

Federally Qualified Health Centers (FQHC) receive federal money through the Department of Health Resources and Services and provide care for underserved populations or areas.[18] FQHC fills maternity care gaps by providing reimbursements through Medicaid which helps providers receive reimbursement for their services.[2] In Houston one FQHC that provided maternity care increased the number of women who received prenatal care by 44%.[19] As of December 2021, 48% of rural counties did not have any FQHC. Urban counties had an average of 3.5 FQHCs per county while rural counties had an average of 1. Half of the counties with no FQHC were also classified as maternity care deserts. Increasing FQHCs can improve maternity care deserts.[2]

Access to doulas

Doulas are non-clinically trained professionals who can support those giving birth through emotional, physical and informational support before, during and after pregnancy. Doulas have shown to improve the experiences of those giving birth. They have been shown to specifically improve maternal outcomes and experiences by reducing stress, anxiety, and pain.[20][21][2] As of August 2022, five states were reimbursing doula services on Medicaid plans and 32 and proposed legislative efforts to provide doula services or Medicaid reimbursements. [22]

Training of midwives and nurses

A midwife examining a patient at a care visit

Patients with midwives are less likely to have preterm births and more likely to have vaginal birth and less adverse outcomes for their infants.[23] In order to increase the numbers of midwives, policy makers have invested in midwifery training programs to make the field more accessible.[24]

Investments in telehealth

Telehealth has been shown to improve obstetric care and early abortion care.[25] Telehealth can be a fast term solution for women in rural areas with a lack of access to care nearby. Telehealth access also overlaps with broadband access as the biggest barrier to telehealth care is internet access.

Medicaid

In addition, Medicaid expansion is associated with lower maternal mortality by 7 out of 100,000 fewer maternal deaths than states with no Medicaid expansion. The evidence suggests that long term coverage before and after pregnancy can reduce rates of maternal mortality.[26]

As of 2023, 41 states have passed amendments that extend Medicaid coverage for 12 months, with 5 states planning on expanding access and two states providing limited expansion. This was originally introduced through an improvision through the American Rescue Plan. The option was made permanent by the Consolidated Appropriations Act 2023.[2]

Current response

Maternal health care has received more legislative attention since the end of Roe v. Wade. The Biden Harris administration has included the phrase "maternity care desert" in their blueprint to tackle maternal health in America.[27] In September of 2023 the U.S. Department of Health and Human Services announced 90 million dollars in funding to support the plan for tackling maternal care in America.[28]

Bills in Relation Passed by 117th Congress[29]
Bills What it Does
Data Mapping to Save Moms' Lives Act It calls on the Federal Communications Commission to include maternal mortality and severe maternal morbidity in its data on its broadband health mapping tool.
Maternal Health Quality Improvement Act of 2021 This bill provides authority to the Department of Health and Human Services to provide grants to support care networks for maternal health in rural areas.
Protecting Moms Who Served This bill directs the Department of Veterans Affairs to implement the maternity care coordination program.

References

  1. 1 2 DiStefano, Sam (2023-08-28). "Confronting the Issue of Maternity Care Deserts". Johns Hopkins Nursing Magazine. Retrieved 2023-11-29.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Brigance, C., Lucas R., Jones, E., Davis, A., Oinuma, M., Mishkin, K. and Henderson, Z. (2022). Nowhere to Go: Maternity Care Deserts Across the U.S. (Report No. 3). March of Dimes. https://www. marchofdimes.org/research/maternity-care-deserts-report.aspx
  3. 1 2 Tanne, Janice Hopkins (2023-08-14). "Nearly six million women in the US live in maternity care deserts". BMJ. 382: 1878. doi:10.1136/bmj.p1878. ISSN 1756-1833. PMID 37580083. S2CID 260887893.
  4. ↑ Taporco, Jason S; Wolfe, Elizabeth; Chavez, Gabriela (1 March 2021). "Kansas Maternity Deserts: A Cross-Sectional Study of Rural Obstetric Providers". Rural and Remote Health. doi:10.22605/RRH6137. PMID 33641336.
  5. ↑ Barrera CM, Kramer MR, Merkt PT, et al. County-Level Associations Between Pregnancy-Related Mortality Ratios and Contextual Sociospatial Indicators. Obstet Gynecol. 2022;139(5):855–865.
  6. 1 2 Wang, Siwen; Rexrode, Kathryn M.; Florio, Andrea A.; Rich-Edwards, Janet W.; Chavarro, Jorge E. (2023-01-27). "Maternal Mortality in the United States: Trends and Opportunities for Prevention". Annual Review of Medicine. 74 (1): 199–216. doi:10.1146/annurev-med-042921-123851. ISSN 0066-4219.
  7. ↑ Declercq, Eugene; Zephyrin, Laurie C. (28 October 2021). "Severe Maternal Morbidity in the United States: A Primer". The Commonwealth Fund. Retrieved 22 December 2023.
  8. ↑ "Why do so many Black women die in pregnancy? One reason: Doctors don't take them seriously". AP NEWS. Retrieved 2023-12-14.
  9. 1 2 3 4 Sonenberg, Andrea; Mason, Diana J. (2023-01-12). "Maternity Care Deserts in the US". JAMA Health Forum. 4 (1): e225541. doi:10.1001/jamahealthforum.2022.5541. ISSN 2689-0186.
  10. ↑ Wallace, Maeve; Dyer, Lauren; Felker-Kantor, Erica; Benno, Jia; Vilda, Dovile; Harville, Emily; Theall, Katherine (2021-03-01). "Maternity Care Deserts and Pregnancy-Associated Mortality in Louisiana". Women's Health Issues. 31 (2): 122–129. doi:10.1016/j.whi.2020.09.004. ISSN 1049-3867. PMC 8005403. PMID 33069560.
  11. ↑ Rader B, Upadhyay UD, Sehgal NKR, Reis BY, Brownstein JS, Hswen Y. Estimated Travel Time and Spatial Access to Abortion Facilities in the US Before and After the Dobbs v Jackson Women's Health Decision. JAMA. 2022;328(20):2041–2047. doi:10.1001/jama.2022.20424
  12. ↑ Westman, Nicole (2023-08-01). "Maternal care deserts overlap with lack of abortion access, analysis shows". ABC News. Retrieved 2023-11-29.
  13. ↑ Declercq, Eugene; Barnard-Mayers, Ruby; Zephyrin, Laurie; Johnson, Kay (2022-12-14). "The U.S. Maternal Health Divide: The Limited Maternal Health Services and Worse Outcomes of States Proposing New Abortion Restrictions". www.commonwealthfund.org. doi:10.26099/z7dz-8211. Retrieved 2023-11-29.
  14. ↑ "Hear Her Texas | Texas DSHS". www.dshs.texas.gov. Retrieved 2023-12-14.
  15. ↑ "Rural Maternal Health Networks: Evaluation Findings from the First Implementation Year of the RMOMS 2019 Cohort – RHIhub Webinar". www.ruralhealthinfo.org. 2022-08-01. Retrieved 2023-12-14.
  16. ↑ "Texas Administrative Code". texreg.sos.state.tx.us. Retrieved 2023-12-14.
  17. ↑ "Blue Cross and Blue Shield of Texas Grants $1.2 million to Fund March of Dimes' First Texas 'Mom and Baby Mobile Health Center'". www.bcbstx.com. Retrieved 2023-12-14.
  18. ↑ "Health Center Program Award Recipients | HRSA". www.hrsa.gov. Retrieved 2023-12-14.
  19. ↑ Shah JS, Revere FL, Toy EC. Improving Rates of Early Entry Prenatal Care in an Underserved Population. Maternal Child Health J. 2018;22(12):1738–1742.
  20. ↑ Gruber KJ, Cupito SH, Dobson CF. Impact of doulas on healthy birth outcomes. J Perinat Educ. 2013 Winter;22(1):49–58.
  21. ↑ Knocke K, Chappel A, Sugar S, De Lew N, Sommers BD. Doula Care and Maternal Health: An Evidence Review. (Issue Brief No. HP-2022-24). Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. December 2022.
  22. ↑ Chen, Amy. "Doula Medicaid Project". National Health Law Program. Retrieved 2023-12-14.
  23. ↑ Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife‐led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub5. Accessed 14 December 2023.
  24. ↑ DiStefano, Sam (2023-08-28). "Confronting the Issue of Maternity Care Deserts". Johns Hopkins Nursing Magazine. Retrieved 2023-12-14.
  25. ↑ DeNicola N, Grossman D, Marko K, Sonalkar S, Butler Tobah YS, Ganju N, Witkop CT, Henderson JT, Butler JL, Lowery C. Telehealth Interventions to Improve Obstetric and Gynecologic Health Outcomes: A Systematic Review. Obstet Gynecol. 2020 Feb;135(2):371–382. doi: 10.1097/AOG.0000000000003646. PMID: 31977782; PMCID: PMC7012339.
  26. ↑ Eliason, Erica L. (2020-05-01). "Adoption of Medicaid Expansion Is Associated with Lower Maternal Mortality". Women's Health Issues. 30 (3): 147–152. doi:10.1016/j.whi.2020.01.005. ISSN 1049-3867.
  27. ↑ House, The White (2022-04-13). "Fact Sheet: Biden-Harris Administration Announces Additional Actions in Response to Vice President Harris's Call to Action on Maternal Health". The White House. Retrieved 2023-12-14.
  28. ↑ "HRSA Invests Nearly $90 Million to Address Maternal Health Crisis | HRSA". www.hrsa.gov. Retrieved 2023-12-14.
  29. ↑ "Recent federal action advances key maternal health policies | National Association of Counties". www.naco.org. Retrieved 2023-12-14.
This article is issued from Wikipedia. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.