Access to maternity care in the greater D.C. region is getting worse according to the 2022 March of Dimes report Nowhere to Go: Maternity Care Deserts Across the U.S.
Maternity care encompasses health care services for women during pregnancy and delivery, as well as after giving birth.
Fairfax County, Virginia, for example dropped from a ranking of moderate to low access since the 2020 report.
“Low access is when we’re in areas that have less than two hospitals or birth centers, and less than 60 obstetric providers per 10,000 births,” said Mallory Mpare, director of maternal infant health initiatives for the March of Dimes in the D.C. area.
“These are counties where there really are not very many options for obstetric providers,” Mpare said. It’s due to a combination of factors, including hospital closures and obstetric providers either leaving the profession or moving elsewhere because of financial factors related to their profession.
D.C. has full access. But there are area counties with low access in Virginia, in addition to Fairfax County, including Prince William and Stafford counties and Fairfax City, and in the area of Front Royal, Virginia, Warren County.
Areas considered to have “moderate” access have two hospitals or birth centers. At the farthest end of the spectrum are maternity care deserts, which have zero obstetric hospitals or birth centers and zero obstetric providers per 10,000 births.
King George County, Virginia, across the Nice-Middleton Bridge from Maryland, is considered a maternity care desert.
“In Maryland and West Virginia, there are counties that have the same issues, particularly along the Eastern Shore of Maryland. We see really limited access, a lot of that has to do with changes in the obstetric care workforce and also in hospital closures,” Mpare said.
Lack of access to maternity care is a growing issue nationwide.
The 2020 report tracked 1,095 counties that were maternity care deserts or low access across the U.S. The 2022 report shows a slight increase of some 1,120 counties that are now maternity care deserts or low access or moderate access.
“We know that maternity care access, having access to good quality maternity care is really predictive of the health of moms and babies in the community. So, it’s certainly not the trend that we want to see,” Mpare said.
So, what’s to blame?
Mpare said the many issues that contribute to the problem include how communities are organized in terms of where people live and where they work. The insurance system could make it easier for women to access and enter care, but there also is a changing dynamic and environment within the health care workforce.
And, she said maternity care units in hospitals are not necessarily the most profitable.
“We have a health care system that is driven by profit. And when we’re going trying to determine what has to go, maternity care units are often on the chopping block,” Mpare said.
What’s the answer?
“It’s going to take a number of different interrelated solutions for us to really see the progress that we hope to see,” Mpare said.
One innovative solution in play locally is health care on wheels to provide people health care where they are.
“Here in the D.C. area, we have a Mobile Health Unit. It’s called our ‘Mom and Baby Mobile Health Center,‘” she said. “Instead of women having to find a maternity care provider in their neighborhood, our Mobile Health Unit comes to them.”
“There are policy solutions too; but we are trying to think innovatively about the many ways that we can approach this issue from multiple angles,” she aid.
What alternatives are available for women considering pregnancy?
“There are solutions,” she said. Options might include expanding access to midwifery care, which Mpare said is an important model for care particularly for low-risk women. She said that can improve access in under-resourced areas.
Also, women might think about who can they add to their care team, such as a doula to help them navigate decisions they have to make. Doulas can sometimes be reimbursed through Medicaid at the state level, including in D.C., Maryland and Virginia.
“All is not lost. It’s just we have to continue to think creatively about how to fill these gaps in maternity care,” Mpare said.
You can see maternity care access rankings for counties nationwide on the March of Dimes website.
