Financing and ownership of hospitals by rural and urban location and obstetric service provision status. (Source: Rural and Urban Hospital Characteristics by Obstetric Service Provision Status, 2010-2018)

A new study from the University of Minnesota Rural Health Research Center has found that when rural hospitals close their obstetrics units, it puts Black and Indigenous mothers at a far greater risk.

Julia Interrante, and Katy Kozhimannil, co-authors of the report, said that the closures of the obstetrics units in hospitals mean black women and infants are more at risk of mortality because of those closures. That’s because the hospitals that close their obstetrics units are more likely to be located in counties where the majority of residents are non-white or Hispanic.

But, the researchers said, the lack of an obstetrics unit did not correspond to a lack of women of reproductive age. Regardless of whether the hospital was in urban or rural areas, or whether it had closed its obstetrics unit, about one in five of the local residents was a woman of childbearing age.

“Just because you close that service doesn’t mean the need goes away,” Kozhimannil said.

Globally, the United States ranks 56th in maternal mortality rate, with 19 deaths for every 100,000 live births – the same as Romania, Moldova, Latvia and Ukraine. And according to the America’s Health Rankings Annual Report in 2018, the American infant mortality rate is 5.9 deaths for every 1,000 births, putting the country 33 out of 36 developed countries. 

The report said that Black women experience 40.8 maternal deaths for every 100,000 live births. For black children, the infant mortality rate is  11 for every 1,000 live births, nearly twice the average.

“These disparities are devastating for families and communities and we must work to eliminate them,” said Emily Petersen, M.D., medical officer at CDC’s Division of Reproductive Health and lead author of the report. “There is an urgent need to identify and evaluate the complex factors contributing to these disparities and to design interventions that will reduce preventable pregnancy-related deaths.”

Because of that, Interrante and Kozhimannil, and others, researched the differences between urban and rural hospitals that provide obstetrics services and compared them to rural hospitals that had closed their obstetrics units.

The research found that hospitals that closed their obstetrics units in rural areas were more likely to be Critical Access Hospitals. Additionally, those that closed their obstetrics units were more likely to be small hospitals.

In the rural hospitals that closed the obstetrics units, however, almost half had the same number of births as most rural hospitals that maintained the service.

“What we see are issues with systemic racism. And we see general, overall health is poor among BiPOC communities particularly black and Indigenous moms,” Interrante said. “And I think you have this combination then when you have an obstetrics unit closing in those same areas that need potentially more care for patients. It’s a compounding problem.”

It’s a problem that’s getting national attention as well.

According to the  U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra  the department will make available $12 million over the next four years for the Rural Maternity and Obstetrics Management Strategies program, as part of the department’s celebration of Black Maternal Health Week. The grants will be used to test models that address unmet needs for rural Black moms. For the first time, HHS said, applicants are required to focus on populations that have historically suffered from poorer health outcomes, health disparities and other inequities.

“Improving maternal health outcomes – particularly among Black women – is priority for the Biden administration and for the Department,” Becerra said. 

Becerra highlighted the decision in Illinois recently to provide continuity of full Medicaid benefit coverage for mothers by offering extended eligibility for a woman during the entire first year after her delivery. Research indicates that coverage gaps in the first six months postpartum often lead to periods of uninsurance, delayed care, and less preventive care.

Interrante and Kozhimannil said that until more states do that, communities where obstetrics units shut down need to make a plan on how to handle pregnancies and births.

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