What prompts me to write about maternity care when expectations around this column probably veer towards something to do with global affairs? Actually, several things.
First, a story several weeks ago about the announcement that Highland District Hospital would be discontinuing obstetrics services for expectant mothers, referring such services elsewhere. Births at the hospital stopped as of Aug. 21, 2022.
Tim Parry, CEO at the hospital, explained that as of 2020 there was a shortage of more than 8,000 OB/GYN physicians nationwide, with that number projected to rise to 22,000 by mid-century. “Simply put, the demand for OB/GYN physicians is exceeding the supply,” he said.
Second, thinking as the grandfather of a recent grandchild, this idea that in a city the size of Hillsboro, in a burgeoning rural county like Highland, with a beautiful hospital like Highland District Hospital, how could it possibly be that Highland County women couldn’t have their babies born in this substantial medical facility? How far will they have to travel? How right is Tim Parry?
Third, the March of Dimes released a new and highly publicized report (https://www.marchofdimes.org/materials/2022_Maternity_Care_Report.pdf) on the topic of maternity-care deserts in rural America, and it’s startling. A map of the maternity deserts shows where these areas are but what is striking about the map is a huge solid red band (indicating maternity desert areas) that spreads from North Dakota south through Texas, defying belief for a country with the wealth of the United States.
Stacey D. Stewart, president and CEO of the March of Dimes, said that, “Maternity care deserts are counties where there is a lack of maternity care resources, where there are no hospitals or birth centers offering obstetric care and no obstetric providers. The 2022 report describes a 2 percent increase in counties that are maternity care deserts since the 2020 report. That is 1,119 counties and an additional 15,933 women with no maternity care.
Some highlights of the report:
· Two in three maternity care deserts are rural counties (61.5%).
· More than 2.2 million women of childbearing age live in maternity care deserts.
· About 4.7 million women live in counties with limited maternity care access.
· The proportion of women living in counties below the national median household income is twice as high for maternity care deserts as it is in full access counties (90.1% and 45.2%, respectively).
· 36 percent of all U.S. counties are designated as maternity care deserts in this report.
· Hospitals limiting obstetric services decreased access to care in 37 counties.
· Hospitals expanding obstetric services increased access to care in eight counties.
· Ohio had the most women impacted by overall reductions in access to care (over 97,000).
So what’s the antidote to this health care crisis in rural America? It helps first to identify the underlying causes to the problem.
1. — 80% of Americans in America live in cities; therefore, available doctors go where the patients are.
2. — Nationwide, according to the March of Dimes, there is a shortage of approximately 8,000 OB/GYN doctors.
3. — A decline in the number of maternity patients in much of rural America makes staffing issues problematic for hospitals.
4. — I would assume Highland District Hospital is competing for a limited number of OB/GYN doctors who seek a full practice of patients and who are well aware of salary differentials between rural, city and suburban practices.
The current administration has proposed debt relief for some students burdened by college debt. Approximately 38,000 farmers are poised to receive federal debt relief given financial circumstances due to the difficulties caused by the pandemic years. Why not offer debt relief to freshly-minted OB/GYNs who agree to work in rural hospitals for a specified number of years?
There’s something to be said for encouraging and developing local talent. Southern State Community College has a great nursing program connected through transfer agreements with the University of Cincinnati, Wright State and four other colleges and universities. Perhaps it could work with local high schools to make sure their curriculums include prerequisite pre-med AP chemistry and biology courses to be both contiguous and sequential with SSCC’s programs and, of course, to bolster students’ interests and applications for medical careers.
What about senior internships at HDH? How influential can they be? I have a daughter who did a senior internship at an Ohio hospital, became interested in medicine, and now is a supervising nurse practitioner in the pediatric intensive care unit at the Cleveland Clinic.
The bottom line is that pregnant women face significant barriers to maternity care in rural America. We can either stand pat or come up with creative and innovative ways to overcome these barriers.
While not specific to maternity care, but nevertheless tangentially connected, a bipartisan bill sponsored by Reps. Susie Lee (D-NV), Dave Joyce (R-OH), Tom O’Halleran (D-AZ) and Brian Fitzpatrick (R-PA) focuses on rural health care. It’s called: “The Improving Access to Health Care in Rural and Underserved Areas Act.” Currently in committee, the Senate version of the bills says it’s, “To establish a program ensuring access to accredited continuing medical education for primary care physicians and other health care providers at federally-qualified health centers and rural health clinics, to provide training and clinical support for primary care providers to practice at their full scope and improve access to care for patients in underserved areas.”
It’s worth repeating.
According to the March of Dimes 2022 report, “Nowhere to Go: Maternity Care Deserts Across the US,” in the past two years, Ohio had the most women impacted by overall reductions in access to maternity care (over 97,000).
Bill Sims is a Hillsboro resident, retired president of the Denver Council on Foreign Relations, an author and runs a small farm in Berrysville with his wife. He is a former educator, executive and foundation president.
Bill Sims Contributing columnist