Two maternity wards at health care facilities in Alabama are planning to close by the end of the month and a third will close a few weeks later, forcing expecting mothers in the area to travel further for care in a state that already struggles with providing birthing care access to its residents, NBC News reported.
People living in Shelby County, one of the largest counties in the state, will have to travel at least 17 miles farther to reach a hospital with an OB-GYN, while those living in Monroe County will be traveling anywhere between 35 to 100 miles to a hospital with an obstetrics unit, said NBC News.
The March of Dimes explained that the farther a woman has to travel to receive maternity care, the greater the risk of maternal morbidity and adverse infant outcomes such as stillbirth.
“There’s a sense of dread knowing that there’s going to be families who are now not only driving to the county over, but driving through three counties,” Honour McDaniel, director of maternal and infant health initiatives for the March of Dimes in Alabama, told NBC News.
The closing of these labor and delivery units only further complicates an ongoing issue of maternal health in Alabama and across the country.
The state has the highest maternal mortality rate in the country, according to a study released in August by the Milken Institute, a nonprofit research group.
According to the March of Dimes, more than a third of Alabama’s counties are considered maternity deserts — having no access to a hospital with obstetrics care, birth centers, OB-GYNs or certified nurse midwives. And on average, a woman has to travel 17.4 miles to get to a hospital with maternal care options.
To put it into further perspective, the March of Dimes said 27.9% of women in Alabama had no birthing hospital within 30 minutes of them — compared to only 9.7% of the entire U.S. facing the same issue — and 2% of women in the state live over an hour away from their nearest birthing hospital.
Mothers aren’t the only ones who suffer due to a lack of accessible care. In their most recent data, the Centers for Disease Control and Prevention reported Alabama as having the third-highest infant mortality rate in 2021, and the March of Dimes gave the state an overall grade of “F” for preterm births.
Furthermore, since Alabama banned abortions with no exceptions for rape or incest last June, it’s expected the demand for obstetrics care will only increase over time.
The closing of these most recent maternity units is attributed to staff shortages and lack of funds, NBC News said.
Maintaining obstetrics care is a financial challenge to some hospitals, since the departments aren’t always profitable, several Alabama physicians told NBC News.
About 9% of the state’s residents have no health insurance, according to a Census Bureau report, and almost half of the births in Alabama are covered by Medicaid — for which reimbursements to hospitals can be substantially lower than from private insurance plans.
But the cost of rural counties losing these maternity services is much greater in terms of risk.
Rural counties that lost birthing services reported more preterm births within the following year than those counties that maintained birthing services, according to a collective study published in 2018. Preterm births can result in fatal factors for newborns, such as low birth weight.
At the brunt of the maternal care disparities in Alabama are Black women, who suffer from a 50% higher preterm birth rate than all other women, the March of Dimes said. They also have a disproportionate share of the burden of maternal death, reported the Milken Institute.
“Nobody wants women and children to do poorly, but you also can’t lose money year over year on a service line,” Dr. John Waits, CEO of the nonprofit Cahaba Medical Care, which runs medical clinics that take patients regardless of their ability to pay, said to NBC News. “There’s something broken about the funding stream that helps us take care of our women and children.”
Taylor O'Bier
