Millions of women in the US are being left without essential healthcare

As maternity care deserts in the US expand, millions of women in rural areas of the US have been left without access to basic maternity care, including labor wards

February 07, 2024 by Peoples Health Dispatch

Women’s health in the United States is at risk due to the growing number of maternity care deserts, in addition to suffering from the effects of the overruling of Roe v Wade. According to estimates by the Center for Healthcare Quality and Payment Reform, 55% of rural hospitals in the US do not provide labor services – meaning that women have to embark on lengthy drives before reaching a place where they can give birth.

While it is known that the rural-urban divide plays a major role in access to women’s health services, with the difference in journey to the nearest maternity wards standing at half an hour or more, other factors are also weighing in. Investigations conducted by journalists in counties with a predominantly Black population point out that Black women in rural areas are even harder hit than others. Rural Black women are three times as likely as rural white women to die of pregnancy-related causes, as pointed out during a webinar organized by the Center for Health Journalism (CHJ).

Most pregnant women living outside of urban areas do not have ready access to hospitals with dedicated obstetrics and gynecology departments. Approximately 2 million women have to travel at least 40 kilometers before reaching the first services of this kind. However, as illustrated by reporters Nada Hassanein and Margo Snipe during the CHJ conversation, the distance grows for women facing complications in their pregnancy and in need of more specialized care.

Watch: What does Texas abortion ban mean for reproductive rights in the US?

It should be pointed out that maternity services do not extend only to labor wards – which have indeed witnessed a wave of closures in rural areas over the past decades – but also to checkups before, during, and after pregnancy. In a situation where the closest gynecological ward is two hours away, many women are forced to forgo consultations and thus face higher risks of developing health issues that can have long-term impacts on both them and their children.

Near the end of last year, the Centers for Disease Control (CDC) reported an increase of 3% in the infant death rate for 2022, along with an increase in congenital syphilis in babies. The rise in syphilis cases represented a tenfold increase compared to ten years ago. Perhaps the most devastating aspect of this was the estimate that some 90% of the cases could have been addressed during antenatal visits – but 40% of the pregnant women infected with syphilis did not receive this kind of care.

Maternity care deserts are also associated with the successful uptake and continuation of breastfeeding, with mothers living in such areas being less likely to successfully breastfeed. According to research by Channel Haley and colleagues, in Louisiana, maternity care deserts were associated with lower breastfeeding rates – with Black mothers being, again, disproportionately affected.

In the US, the dearth of maternity care services in rural areas has been a long-term problem. Most public health officials and journalists who have tried to tackle it warn that the problem will not go away until more efforts at state and federal levels are made to increase access to care. This includes the expansion of Medicaid benefits for new parents, as well as building an adequate health workforce, made of enough midwives and gynecologists.

Their calls are not being heeded at this point in time, however. Instead of ensuring the presence of health services in all parts of the country, authorities are looking away while rural health services remain under the threat of further closures.

People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and subscription to People’s Health Dispatch, click here.