Introduction:
Across America, a quiet yet profoundly concerning crisis is unfolding: labor and delivery centers are closing their doors at an alarming rate leaving millions of women – especially those in rural communities – without accessible, timely maternity care. This troubling phenomenon has given rise to what healthcare experts are now calling “maternity care deserts,” areas where expectant mothers must travel extensive distances to receive critical prenatal and labor care services. Why is this happening, and what can be done to reverse this worrying trend?
The Reality of Maternity Ward Closures
In recent years, a concerning trend has become apparent in America’s healthcare landscape -birthing units are closing at an unprecedented pace. According to a recent report by the March of Dimes, over 300 labor and delivery centers nationwide ceased operation since 2018. This number alone paints a distressing picture, but the impact behind these closures is even more profound.
Maternity care deserts now affect nearly five million women of childbearing age, many of whom are located in rural or low-income communities. This has created alarming inequities, with pregnant women having significantly fewer options and facing increased risks of pregnancy-related complications due to delayed access to essential care.
The widespread closures significantly disrupt communities, leaving mothers-to-be grappling with anxiety, uncertainty, and real health risks – especially if they experience complications or have high-risk pregnancies.
Key Reasons for Closures
- Financial Pressures: High Costs and Low Reimbursement Rates
One of the most significant factors driving these closures is economic: the financial pressures on hospitals, especially smaller or rural ones, are immense. Labor and delivery units are costly to maintain due to specialized staffing requirements, expensive equipment, and stringent regulatory compliance standards. Unfortunately, these high operational expenses often outpace revenue streams from maternity services.
A critical contributor to these financial woes is insufficient reimbursement. Medicaid, which covers nearly half of births in the U.S. and an even higher percentage in rural and low-income areas, typically offers reimbursements far below the actual costs of providing maternity care. These reimbursement shortfalls make it challenging for hospitals to maintain maternity wards, compelling hospital administrators to cut these financially unsustainable departments altogether.
- Workforce Shortages: The Shrinking Pool of OB-GYN Specialists
Another major factor contributing to the closures is the pronounced shortage of obstetrician-gynecologists (OB-GYNs), especially in rural and underserved regions. According to the American College of Obstetricians and Gynecologists (ACOG), nearly half of U.S. counties currently lack a single practicing OB-GYN.
The underlying causes for these shortages are multifaceted:
- Demographic shifts: Many current OB-GYN specialists are nearing retirement age without sufficient numbers of new physicians to replace them.
- Challenges attracting talent to rural communities: Rural hospitals often struggle to offer competitive salaries, professional opportunities, and quality of life attractive enough to recruit and retain new graduates.
- High workloads and burnout: Due to these shortages, remaining practitioners face intense workloads, long hours, and increasing burnout rates, perpetuating the cycle of staffing issues and hospital closures.
- Declining Birth Rates: Reduced Demand
The U.S. is experiencing steadily declining birth rates, a trend exacerbated by changing economic conditions, shifting social dynamics, and evolving family planning practices. Fewer births mean fewer patients in maternity units, reducing overall utilization rates. With fixed overhead costs like staffing, supplies, and infrastructure maintenance, hospitals are finding it increasingly difficult to justify maintaining labor and delivery units when demand declines.
As birth numbers drop, particularly in rural communities where population declines and aging demographics are prevalent, hospitals face tough financial decisions about which departments can remain operational. Unfortunately, maternity wards, despite their critical role, often become prime candidates for closure.
For More:
This is the first blog in our series exploring the causes of maternity care deserts, their impact on communities, and possible solutions. Click here to read part two in this series.