Maternal health: Access in crisis

By: Ellen Allen

January 25, 2024

Rural access to maternal care grows ever more challenging, with more than one-third of U.S. counties considered maternity care deserts, and according to a 2022 March of Dimes report, West Virginia received a failing grade for infant and maternal health. 

It is undeniable that infants and people giving birth are dying at increasingly alarming rates. While much national data exists on mortality rates — an essential data point measuring the overall health of a society — West Virginia’s public health statistics severely hamper our state’s ability to make relevant  policy recommendations that can reverse this dire public health crisis. 

At the same time, access to maternal health care has increasingly become unobtainable for many patients in the United States. Ongoing financial, staffing, and policy challenges have forced hospital administrators in both rural and urban areas to shutter their labor and delivery units, causing patients to travel longer distances or go without needed care. 

The national average of preterm births, defined by the World Health Organization as babies born alive before 37 weeks of pregnancy are completed, is 10%. West Virginia’s average is 13% — and the outcomes are even worse for babies born to Black birthing parents.

The preterm birth rate for Black babies is 1.4 times higher than the rate among all other babies while the infant mortality rate among babies born to Black birthing people is 1.6 times higher than the state rate. According to the report, from 2019 to 2021, the leading causes of infant death in West Virginia were birth defects, preterm births or low birth weight and maternal complications.

How do we allow this to stand? 

Access to maternity care in West Virginia, especially among Black, Indigenous and people of color is not consistently available as just over 49% of counties are defined as maternity care deserts compared to 32.6 percent in the U.S.

  • In West Virginia, there was a 10% decrease in the number of birthing hospitals between 2020 and 2019. 
  • In West Virginia, there were 3,449 babies born in maternity care deserts, 20.1% of all births. 
  • In West Virginia, 16.3% of babies were born to women who live in rural counties, while 5.8% of maternity care providers practice in rural counties.

The farther a woman travels to receive maternity care, the greater the risk of maternal morbidity and adverse infant outcomes, such as stillbirth and NICU admission. Furthermore, longer travel distances to care can cause financial strain on families and increased prenatal stress and anxiety. The distance a woman must travel to access care becomes a critical factor during pregnancy, at the time of birth, and in the case of emergencies. Nationwide closures of birthing hospitals have contributed to increased distance and travel time to care, especially in rural areas.

  • In West Virginia, women travel 14.2 miles and 20.7 minutes, on average, to their nearest birthing hospital.  
  • Women living in counties with the highest travel times (top 20%) could travel up to 59.9 miles and 76 minutes, on average, to reach their nearest birthing hospital.
  • Under normal traffic conditions, 2.6% of women live more than 60 minutes from their nearest birthing hospital compared to 1% in the U.S.
  • 22.2% of women in West Virginia had no birthing hospital within 30 minutes.
  • In rural areas across West Virginia, 42.2% of women live over 30 minutes from a birthing hospital compared to 19.1% of women living in urban areas.
  • Women living in maternity care deserts traveled 2.9 times farther than women living in areas with full access to maternity care in West Virginia.

Early and regular prenatal care is an important strategy for reducing the risk of pregnancy complications and adverse birth outcomes.  Historically, Black, Indigenous and people of color have lower rates of adequate prenatal care and may be less likely to receive services such as important health screenings and appropriate monitoring of baby’s growth. Community level factors, such as poverty, create barriers to accessing care that can worsen the disparity in prenatal care usage among Black, Indigenous and people of color

We know access to doula services results in better birth experiences and outcomes. West Virginians for Affordable Health Care support legislation that would pay for doula services through Medicaid. This is a common sense solution to a calamitous public health development that should never be accepted in a society of such great wealth. 

The impact of poverty on prenatal care usage was assessed by examining the percent of women receiving inadequate prenatal care in areas of high and low poverty. In West Virginia, 14.5% of women received inadequate prenatal care compared to 14.8% in the U.S.

  • 2.9% of Black, Indigenous and people of color did not receive prenatal care in areas of high poverty. 
  • Among Black, Indigenous and people of color, those living in areas of high poverty have a 22% increased likelihood of inadequate prenatal care when compared to those living in areas of low poverty. 
  • Hispanic women living in areas of high poverty are 1.7 times more likely to receive inadequate prenatal care compared to those in areas of low poverty.

All women deserve health care which is safe, effective, timely, efficient and equitable. Consistent and equitable access to maternity care helps women maintain optimal health as well as reduce the risk of experiencing complications during pregnancy and the postpartum period. 

Together this information can lead lawmakers, public health professionals, clinicians and researchers to advocate for policies and resources that increase maternity care access across the Mountain State.   

By addressing these factors, West Virginia can move closer to eliminating pregnancy-related deaths and complications. 

The maternal access crisis in the United States is nothing short of catastrophic. We can all play a role in helping to reverse course and improve outcomes. Access to maternal health care is at risk in West Virginia and how the lives, health, and safety of patients depend on stakeholders coming together to develop sound policy solutions and implement programs and initiatives to restore and protect access to care.