Rural hospitals are losing money on their obstetrics programs, but many are keeping these wings open anyway, according to a recent national survey.
“Local community needs were the top reason and many cited poverty in their communities,” said Katy Backes Kazhimannil, director of the University of Minnesota Rural Health Research Center. She led the survey of rural hospitals, the findings from which were published last month.
Hospital administrators reported needing, on average, 200 births per year to safely provide maternity services and remain financially viable. Yet more than one-third of hospitals that responded to the survey had fewer births than the minimum they needed. And about 20% of respondents said they were unsure whether they'd still be offering obstetrics care in 10 years.
Backes Kazhimannil said inequality is at the heart of the problem.
“These statistics represent a longstanding underinvestment, predominantly in rural, tribal and Black communities,” she said.
The survey findings also signal, Backes Kazhimannil said, “the need to reinvest in these places and to really take an honest look at the consequences of decades of treaties not being honored, investments not being made in some of the most vulnerable communities in our country.”
This includes improving access to high-quality preconception, maternity, and postpartum care.
Respondents acknowledged the grave consequences of shutting down, such as maternal and infant mortality that's more likely to hit families of color – "exponentially more" likely, as one recent study found. CDC data show Black women die from pregnancy-related issues at a rate three times higher than other groups, while Native women are twice as likely to die.
Roughly 30% of the survey’s participants operate in the Mountain West. Backes Kazhimannil says rural communities in the region and beyond face an even broader public health crisis where the difficulties of providing maternal and rural health care converge.
This is especially true for Indigenous women in the region.
Her research has shown some of the highest rates of severe morbidity and mortality are among Indigenous people. “And then it's even more exacerbated when you look among Indigenous people who are rural residents living in some of our most rural tribal lands, frontier lands and other areas,” she said.
Backes Kazhimannil points to several causes. For one, many Indian Health Service facilities do not provide childbirth care, so Native people often travel great distances to see doctors. They also often lack support and resources such as access to healthy foods and access to jobs.
“The burdens fall disproportionately on the most vulnerable communities, the most remote, tribal and frontier rural communities, and on Black and Indigenous rural communities,” Backes Kazhimannil said.
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Nevada Public Radio, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.