More than half of rural communities in America did not have obstetric services in 2018, according to the Government Accounting Office (GAO). The increasing difficulties accessing obstetrics and prenatal care appears to be worsening nationwide with more women living in maternity deserts, affecting sparsely populated areas as well as Black communities and areas of low income, as described in a recent article on the Washington State Department of Health’s HEALWA resource site.

The article author, Lucy Li described the recent closure of Astria Toppenish Hospital’s Family Maternity Center, located in the rural Yakama Valley in Washington. As a result, maternity care is redirected to hospitals further away, reducing access to this essential service for members of the nearby Yakama Indian Reservation as well as other communities in the area including Toppenish.

Li also cites a  Policy Paper by the National Rural Health Association that notes that “long travel distances to obstetric and prenatal care visits due to local rural hospital maternity unit closures have led to negative health conditions, such as premature births, nonindicated induction, and C-sections.”

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Obstetric Unit Closures Create Maternity Deserts

According to the American Hospital Association, rural hospitals represented 35% of the nation’s community hospitals and delivered 1 in 10 babies in the US. Yet half of these hospitals did not offer obstetric services in 2020. Furthermore, between 2015 and 2019, at least 89 obstetric units closed in these rural hospitals, leaving 2.2 million childbearing-aged women living in “maternity deserts.”

The increasing health inequality facing rural residents is not without novel and common-sense actions that would help address the problem. For example, Li describes proposed initiatives such as providing financial incentives to medical providers to practice in rural settings, with one goal being the likely increase in Ob-prenatal care in such settings.

Current programs already exist, offering financial assistance to medical students in the form of scholarships to medical students via programs such as the University of Washington’s Rural and Underserved Opportunities Program. Li notes one study showing that medical students who participate in such programs are more likely to practice in rural communities upon finishing their medical training.

While these ideas for addressing maternity deserts sound promising, the challenge for communities and the medical system as a whole is to find the will and the funding to begin urgently addressing these access issues.