Policy advisors: America’s ‘crisis in rural maternity care’ cries out for attention

Maternity care is in danger of vanishing from rural communities across the U.S., and two addressable if not reversible trends largely account for the peril: clinician shortages and tightfisted reimbursements.

The first could be ameliorated with concerted recruitment assistance, the second with wise policy prescriptions.

The perspective is from the Center for Healthcare Quality and Payment Reform (CHQPR), a small but influential advisory firm based in Pittsburgh. In a report first issued in 2023 but newly updated with data from January 2024, the organization expounds on its dual recommendations for solving what it calls America’s “crisis in rural maternity care.”

“It is not enough to simply train more physicians and nurses and hope that they will be willing to work in rural areas,” the report states. “Medical and nursing students need to be recruited and trained specifically to deliver team-based care in rural areas.”

Meanwhile, employers “should require their health insurance plans to demonstrate that they are paying amounts that are adequate to cover the cost of maternity care services,” CHQPR maintains. “Similarly, states should require Medicaid plans to pay adequate amounts for maternity care services.”

The report presents statistics to underscore CHQPR’s view that the problem calls for immediate action. Among the bracing numbers:

1. More than half (55%) of the rural hospitals in the U.S. do not offer labor and delivery services. In 10 states, more than two-thirds do not.
2. Over the past decade, more than 200 rural hospitals across the country have stopped delivering babies.
3. Of rural hospitals that still have labor and delivery services, more than one-third have been steadily losing money on patient services overall. This increases the risk to maternity service lines.
4. Contrary to widespread perceptions, low Medicaid payments and uninsured patients don’t explain rural hospitals’ money woes. Indeed, more than 40% of births in rural communities are paid for by private health plans, many of which provide insufficient payments for the range of maternity care services.
5. In rural areas, the travel time to a hospital with labor and delivery services is likely to be at least 30 minutes. It’s not uncommon for some areas to see travel times topping 40 minutes. By comparison, in many if not most urban and suburban areas, hospital travel times are under 20 minutes.

Underpinning all these challenges is the stark reality that the U.S. has the highest rates of mortality for both infants and mothers among the world’s advanced economies, CHQPR points out.

In fact, pregnant women are three times as likely to die in the U.S. as in Australia, Britain, Canada, France, Germany and other developed countries—a gap that has only widened as maternal mortality rates have continued rising over the past several years.

CHQPR concludes:

“It is not an exaggeration to say that rural maternity care is in a state of crisis, and a crisis demands immediate action. Every day that steps are not taken to implement the changes in workforce recruitment and payments described above increases the likelihood that more women and babies will die unnecessarily.”

According to the U.S. Census Bureau, around 60 million people—or 1 in 5 Americans—live in rural America.

Read the full CHQPR report on rural maternity care.