New federal and state efforts to pump funding into threatened rural maternity-care programs are underway, but it may be years before anyone will be able judge whether those efforts are effective at preventing the closure of more facilities, advocates say.
More than 200 rural hospitals across the country have stopped providing labor and delivery services in the past 10 years, according to the Center for Healthcare Quality and Payment Reform (CHQPR). The closures mean that more than half of rural hospitals in the U.S. (55%) have stopped delivering babies. It also means rural moms will have to drive farther to get to a hospital that can deliver a baby, putting them at higher risk if the complications arise.
Increased federal and state attention to the crisis has seen grant dollars funneling into communities and new programs receiving government money. But advocates said not only is it too soon to tell if the spending is effective, it will be years before rural communities benefit from it. Even with federal investments, and state initiatives, advocates said, the rural maternal health crisis isn’t likely to be solved in a day, a year or even an administration.
In 2022, the President Joe Biden’s administration released a “Blueprint for Addressing the Maternal Health Crisis” that looked at the issue. It focused on five strategies – increasing access to and coverage of maternal health services; ensuring those giving birth are heard and decision makers are held accountable; advancing data collection and research strategies; expanding and diversifying the perinatal workforce; and strengthening the economic and social supports for people before, during and after pregnancy.
Alyssa Fritz, research and Policy Fellow at the University of Minnesota’s Rural Health Research Center, said it was too soon to tell what kind of progress the administration’s plan has made.
“Not enough time has passed since the Blueprint was released to tell whether we are moving the needle, since the latest data we have for most measures are from 2021 or 2022,” she said in an email interview. “HHS has said it plans to track progress, but as of now there is little information about what office(s) will be tracking performance, and how.”
One of the most important factors, Fritz said, was ensuring people have health insurance.
“We know that access to health insurance is a critical factor in people seeking health care when they need it,” she said. “We also know that one-third of maternal deaths occur between 1 week and 1 year after childbirth; this was one of the driving motivations behind the push to extend postpartum Medicaid coverage from 60 days to 12 months postpartum. At this point, 47 states and DC have extended postpartum Medicaid or are in the process of doing so.”
The change is too recent to analyze its effect on health care access or on maternal health outcomes, but research done previously has shown that Medicaid expansion could have a positive effect on postpartum patients accessing care, which could ultimately save lives, she said.
As part of the administration’s initiative, U.S. Department of Health and Human Services (HHS) announced in September of last year that it was investing nearly $90 million in programs designed to expand access to maternal health care, support maternal health in rural and disadvantaged communities, and grow support for the maternal health workforce.
That included a $34 million investment by HHS’s Health Resources and Services Administration (HRSA) to increase access to maternity care in underserved and rural communities, including more than $2 million specifically targeted to rural communities.
Among those receiving federal grant money is Frontier Nursing University in Versailles, Kentucky. Established as a school for midwives and family nursing in 1939 in Hyden, Kentucky, the school receives federal funding from four different grants, said the school’s president, Dr. Susan Stone.
Even with the added investments, Stone said in an interview with the Daily Yonder, the issue is so complex it will take time to adequately address it.
“We are going to have to invest in rural health more than just giving some scholarships to some midwifery students… We’ve got to put more money into rural health clinics, into more health care providers, and into learning how to understand our own biases in the health care system,” she said. “I don’t think we’re going to see this turn around, unless we have put a lot more effort into it.”
There needs to be investment into rural birthing centers, she said, as well as investment into rural mental health facilities and drug addiction treatment facilities. There needs to be a change, she said, where women’s health and birthing are a priority.
“You know, we don’t hesitate in this country to do a knee replacement or hip replacement,” Stone said. “If you want a hip replacement, you’re going to be able to get that… If you want maternity care, it might not be there for you.”
One aspect of making sure maternal healthcare stays in rural communities is making sure the hospitals that house them get paid for their services, Harold Miller, founder of CHQPR. And that means paying hospitals what it costs to provide those services. Miller said the costs to provide those services are higher at rural hospitals because there are fewer people from which to recoup what it takes to run and staff an obstetrics unit.
As it is, he said, with more rural hospitals possibly losing maternity services, leaving rural residents with fewer and fewer choices for maternity care.
“Because the cost has been going up, you’re going to start seeing hospitals the bottom increasingly peeling away,” Miller told the Daily Yonder.
“The assumption is somehow they’re all going to go to another hospital and that hospital would be fine because it’s going to get a higher volume… But it’s not reasonable to think that mothers will just plan to go to the hospital that is an hour away. Some people just don’t have the resources to do that.
Republish our articles for free, online or in print, under a Creative Commons license.
