In the United States, over 5.6 million pregnant people live in areas with little to no access to maternity care services, according to new research from March of Dimes. Advisory Board's Gabriela Marmolejos and Lilli Silverston recommend three things stakeholders can do to reduce maternity care deserts and improve pregnancy outcomes.
By Gabriela Marmolejos and Lilli Silverston
In our 2023 maternal & reproductive health market trends presentation, we noted that maternity care deserts have severely reduced access to pregnancy care nationwide. Maternity care deserts are associated with a lack of adequate use of prenatal care services or treatment for pregnancy complications, and an increased risk of maternal death.
Maternity care deserts disproportionately impact groups that already face a higher risk of pregnancy complications, including people living in rural communities, people with low incomes, and Black and Native American people.
Earlier this month, March of Dimes released a collection of reports that found that access to maternity care is worsening in many areas of the United States. Overall, the United States experienced a 4% decline in hospitals that offer labor and delivery services from 2019 to 2020.
According to the report, over 5.6 million pregnant people currently live in counties with little to no access to maternity care services.
Since March of Dimes released its first report in 2018, the loss of obstetric units in hospitals has led to decreased access to maternity care in 369 counties — almost one in 10 counties nationwide. During the same period, 70 additional counties were classified as maternity care deserts following the loss of obstetric providers and obstetric units.
A lack of access to reproductive healthcare services — such as family planning clinics and skilled birth attendants — has put over 32 million reproductive-age women at risk of poor health outcomes.
However, rural states — including North Dakota, South Dakota, Alaska, Oklahoma, and Nebraska — have experienced the highest rates of maternity care deserts.
"A person's ability to have a healthy pregnancy and healthy birth should not be dictated by where they live and their ability to access consistent, quality care but these reports [show] that, today, these factors make it dangerous to be pregnant and give birth for millions of women in the United States," said Elizabeth Cherot, March of Dimes president and CEO.
"Our research shows maternity care is simply not a priority in our healthcare system and steps must be taken to ensure all moms receive the care they need and deserve to have healthy pregnancies and strong babies," Cherot added. "We hope the knowledge provided in these reports will serve as a catalyst for action to tackle this growing crisis."
According to CDC, more than 80% of pregnancy-related deaths in the United States are preventable. Healthcare leaders have a role to play in reducing maternity care deserts to improve pregnancy outcomes. Here are three ways healthcare stakeholders can respond:
1. Providers can expand their reach with mobile units and satellite clinics
Providers can leverage creative partnerships to reach pregnant people living in maternity care deserts.
For example, the University of Maryland Capital Region Health partnered with March of Dimes to offer free maternity, infant, and reproductive health services through their Mama and Baby Mobile Health Unit that travels throughout Prince George's County in Maryland and parts of Washington, D.C.
Providers can also open satellite obstetric clinics in maternity care deserts, where local providers partner with obstetricians at nearby hospitals to provide patients with comprehensive prenatal and postpartum care.
2. Payers can create care management programs to address gaps in maternity care
Payers should consider allocating resources to maternity care management programs that improve care access for those who need it most.
For example, Health Partners Plan launched Baby Partners Plan to support people with high-risk pregnancies and their babies throughout the prenatal and postpartum periods. The program offers several services including virtual visits, home visits by a doula or nurse, and transportation to in-person care. This effort allows those living in maternity care deserts to seamlessly access maternity care closer to home.
The Baby Partners Plan resulted in a 14% reduction in infants with low birth weight, a 20% increase in postpartum office visits, and $1.5 million in cost savings in the first three months among program participants.
3. Digital health companies can develop solutions to enable pregnancy care closer to home
Digital health companies have an opportunity to build platforms to help close the gaps in maternity care deserts nationwide.
For example, Maven Clinic, a digital health startup, partners with health plans and employers to provide members and employees with accessible maternity care and family-building options. Pregnant people in maternity care deserts can use this end-to-end platform to access virtual visits with remote patient monitoring, personalized care plans, and asynchronous messaging with clinicians. (March of Dimes report, 8/1; Ollstein/Messerly, Politico, 8/1; March of Dimes news release, 8/1; DeLetter, USA Today, 8/1)
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