According to a new report from the Center for Healthcare Quality and Payment Reform (CHQPR), more than half of rural hospitals in the United States do not offer maternity care — findings that emphasize a need to preserve and strengthen maternity care in these areas.
Over the last ten years, more than 200 rural hospitals across the United States have stopped offering maternity care. Currently, over half of rural hospitals (55%) do not offer labor and delivery services, and in 10 states, more than two-thirds do not have maternity care.
Many more rural communities are also at risk of losing their maternity care services as rural hospitals face ongoing financial and workforce challenges. According to CHQPR, it can be difficult for rural hospitals to staff 24/7 maternity care. Commercial and Medicare payments are also often inadequate to cover these services.
Over a third of rural hospitals still providing maternity care reported an overall loss on patient care services, "so their ability to continue delivering maternity care is at risk," CHQPR wrote. In 12 states, over half of rural maternity care hospitals reported patient care losses.
With fewer hospitals offering maternity care, patients in rural areas will have to travel farther to access these services. Although patients in urban areas can usually travel to a hospital with maternity care in under 20 minutes, rural patients may have to travel at least 30 minutes, with many traveling for more than 40 minutes.
"There is a higher risk of complications and death for both mothers and babies in communities that do not have local maternity care services," CHQPR wrote. "Women are less likely to obtain adequate prenatal and postpartum care when it is not available locally."
Currently, the United States has the highest infant and maternal mortality rates among developed countries, and the problem has only worsened in recent years. Between 2018 and 2021, U.S. maternal mortality rates almost doubled.
"Although improvements in maternity care are needed in all parts of the country to address this problem, one of the greatest challenges is in rural areas, because most rural hospitals are no longer providing maternity care at all," CHQPR wrote. "… It is not an exaggeration to say that rural maternity care is in a state of crisis, and a crisis demands immediate action."
According to CHQPR, addressing workforce recruitment and payment challenges will be key to preserving and strengthening access to maternity care services in rural areas. Some recommendations include training medical and nursing students specifically for rural maternity care and ensuring health plans and Medicaid offer adequate payment for maternity care services in rural areas.
Advisory Board's Gabriela Marmolejos and Lilli Silverston have also outlined ways stakeholders can reduce maternity care deserts and improve pregnancy outcomes in the United States, including:
For more resources on issues related to maternity care, check out these ready-to-use-slides on the trends impacting maternal and reproductive care or read the top drivers of change in the maternal and reproductive health market. This report can also help you address the root causes of maternal health inequity, including enduring legacies of institutional racism and women's healthcare being deprioritized.
Advisory Board also has several resources on how to utilize technology in maternity care, including this cheat sheet on telehealth and maternity care. Similar resources include these expert insights on how telehealth helped improve pregnancy outcomes and patient retention in rural Georgia. (Millman, Axios, 1/23; Muoio, Fierce Healthcare, 1/23; Center for Healthcare Quality and Payment Reform report, accessed 1/24)
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