REPRODUCTIVE JUSTICE: NOT JUST ABORTION, NOT JUST WOMEN

**NOTE**  Medical advancements have saved the lives of women and babies at risk for injury or death during pregnancy and birth.  This site is not about the doctors who properly use interventions to save lives; it is about those who use them unethically for profit or convenience.   Improperly used interventions have led to harm and death of women and babies and obstetrics  is the only field in which mortality rates are rising and non-medically needed interventions such as c-sections are related to 66% of maternal deaths. 

**NOTE**  This site is designed to share valid evidence for those working to change the maternal healthcare system who do not have access to databases of peered research. 

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**NOTE** Chronological order allows users to find new data.  It also begs the question of why, when we have known for decades that such practices are harmful, do they not only continue to be used but are increasingly used.

RURAL MATERNAL HEALTH and MATERNAL HEALTH DESERTS

WHAT DOES THE LITERATURE SAY?

Regularly Updated Sites

March of Dimes Peristats.  Report cards for all states.  Accessed https://www.marchofdimes.org/peristats/ 

2023

Giragosian, L. (2023). Addressing the Impact of Rural Hospital Closures on Maternal and Infant Health.  Accessed https://www.astho.org/communications/blog/addressing-impact-rural-hospital-closures-on-maternal-infant-health/

• Nearly 200 rural area hospitals have closed since 2005, leaving more than 50% of all rural counties without access to hospital obstetric services. There are limited rural hospitals, and when even a few hospitals are closed, it greatly impacts community access to care. Rural hospital closures exacerbate poor socioeconomic conditions, job loss, cost of health services, transportation times and barriers, and inequitable access to quality care, all of which contribute to unfavorable maternal and infant health outcomes.

Harrington, K., Cameron, M., Culler, K., Grobman, W. and Khan, S. (2023). Rural-Urban Disparities in Adverse Maternal Outcomes in the United States, 2016 - 2019.  American Journal of Public Health. Accessed https://ajph.aphapublications.org/doi/10.2105/AJPH.2022.307134

• Conclusions.Pregnant individuals in rural areas are at higher risk for ICU admission and mortality than are their urban counterparts. Significant increases in maternal mortality occurred in rural and urban areas.

Harvard T.H. Chan School of Public Health (2023). Federal Action Needed to Halt Maternity Ward Closures  Accessed https://www.hsph.harvard.edu/news/hsph-in-the-news/federal-action-needed-to-halt-maternity-ward-closures-says-expert/

• “Countries like France, the U.K., and Australia have maternal care workforces that are largely made up of midwives, and they have much better outcomes than us. So this might actually bode well for maternal health outcomes in general,” McGregor said

Jeffers, N. (2023). Confronting the Issue of Maternity Care Deserts. Johns Hopkins Nursing.  Accessed https://magazine.nursing.jhu.edu/2023/08/confronting-the-issue-of-maternity-care-deserts/#:~:text=Almost%206%20million%20birthing%20people,obstetrician%2Fgynecologists%20(OBs).

• Almost 6 million birthing people live in a US county classified as a maternity care desert,  an area with limited or no access to an obstetric provider like certified nurse midwives/certified midwives (CNMs/CMs) or obstetrician/gynecologists (OBs). In 2020 one in 12 birthing people live in a maternity care desert and there are significant disparities in access. Approximately 1 in 4 of Native American babies (26.7%) and 1 in 6 Black babies (16.3%) were born in maternity care deserts. 

Sonenberg, A. and Mason, D. (2023). Maternity Care Deserts in the US.  Accessed https://jamanetwork.com/journals/jama-health-forum/fullarticle/2800629

• In 1991, the federal government launched Healthy Start to improve maternal-child health outcomes. In 2021, the program provided more than $115 million in funding for 101 community collaborations to improve access to perinatal care, empower women to adopt healthy behaviors, and provide pregnancy and early childhood supports. Although infant mortality rates have improved, the nation’s maternal mortality rate increased from 17.4 deaths per 100 000 live births in 2018 to 23.8 deaths per 100 000 live births in 2020, with the rate for Black women nearly triple that of White women. The US has the highest maternal death rate among high-income countries—nearly 3-fold higher than France, the country with the second-highest maternal death rate.

2022

Center for Medicare and Medicaid Services (2022).  Improving Access to Maternal Healthcare in Rural Communities. Accessed https://www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health/09032019-Maternal-Health-Care-in-Rural-Communities.pdf

• A lack of access to high quality maternal health services in rural communities is the result of many factors including hospital and obstetric department closures, workforce shortages, and access to care challenges arising from the social determinants of health which have contributed to disparities in maternal health care for rural women and their babies. These access challenges can result in a number of negative maternal health outcomes including premature birth, low-birth weight, maternal mortality, severe maternal morbidity, and increased risk of postpartum depression.

March of Dimes (2022). Maternity Care Deserts Report.  Accessed https://www.marchofdimes.org/maternity-care-deserts-report

• March of Dimes has released its 2022 report on maternity care deserts across the United States—counties where there’s a lack of maternity care resources, where there are no hospitals or birth centers offering obstetric care and no obstetric providers.

U.S. Government Accounting Office (GAO). (2022). Maternal Health: Availability of Hospital Based Obstetric Care in Rural Areas. Accessed https://www.gao.gov/products/gao-23-105515

• Research indicates that the number of rural hospitals providing obstetric services declined from 2004 through 2018, and more than half of rural counties did not have such services in 2018, according to the most recent data available. Studies showed that closures were focused in rural counties that were sparsely populated, had a majority of Black or African American residents, and were considered low income. Studies also showed differences in the type of clinicians delivering babies in rural and urban areas.

2021

Rural Health Information Hub (2021). Rural Maternal Health Toolkit.  Accessed https://www.ruralhealthinfo.org/toolkits/maternal-health

• The toolkit compiles evidence-based and promising models and resources to support rural communities implementing maternal health programs across the United States.

2020

Millett, S.(2020).  Child and Maternal Health in Rural Areas Lags the Nation, Highlighting Barriers to Access. Accessed https://www.pewtrusts.org/en/research-and-analysis/articles/2020/02/25/child-and-maternal-health-in-rural-areas-lags-the-nation-highlighting-barriers-to-access

• One in five Americans lives in a rural area, including about 18 million women of reproductive age, but key indicators, including mortality figures, show that the health of mothers and children in these communities lags behind that of their urban peers and is worsening.

2019

Kozhimannil, K., Interrante, J., Henning-Smith, C. and Admon, L. (2019). Rural-Urban Differences in Severe Maternal Morbidity and Mortality in the U.S., 2007-2015.  Accessed https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00805

• Using data for 2007–15 from the National Inpatient Sample, we analyzed severe maternal morbidity and mortality during childbirth hospitalizations among rural and urban residents. We found that severe maternal morbidity and mortality increased among both rural and urban residents in the study period, from 109 per 10,000 childbirth hospitalizations in 2007 to 152 per 10,000 in 2015. When we controlled for sociodemographic factors and clinical conditions, we found that rural residents had a 9 percent greater probability of severe maternal morbidity and mortality, compared with urban residents

2017

Maron, D. (2017). Maternal Healthcare is Disappearing in Rural America. Accessed https://www.scientificamerican.com/article/maternal-health-care-is-disappearing-in-rural-america/

• The disappearing maternal care problem is common across rural America. Only about 6 percent of the nation’s ob–gyns work in rural areas, according to the latest survey numbers from the American Congress of Obstetricians and Gynecologists (ACOG). Yet 15 percent of the country’s population, or 46 million people, live in rural America. As a result, fewer than half of rural women live within a 30-minute drive of the nearest hospital offering obstetric services. Only about 88 percent of women in rural towns live within a 60-minute drive, and in the most isolated areas that number is 79 percent.

2014

ACOG (2014).  Health Disparities in Rural Women.  Accessed https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2014/02/health-disparities-in-rural-women

• Rural women experience poorer health outcomes and have less access to health care than urban women. Many rural areas have limited numbers of health care providers, especially women’s health providers. Rural America is heterogeneous where problems vary depending on the region and state. Health care professionals should be aware of this issue and advocate for reducing health disparities in rural women.

INTRODUCTION PAGE

Last updated June  2024