Maternal Health Care Is Disappearing in Rural America – By Dina Fine Maron on February 15, 2017


Many women must travel an hour or longer to find a hospital where they can deliver their babies

Credit: Ian Waldie Getty Images

By the time the pregnant woman arrived at the nearest hospital with a maternity ward—90 minutes after leaving her home in Winfield, Ala.—she was ready to deliver her baby. She made it just in time, recalls Dan Avery, an obstetrician–gynecologist who tended to patients in rural Alabama and elsewhere until his recent retirement. Too often, he says, patients are not so lucky. Some have ended up delivering on the side of the road. Winfield, located in the northwestern part of the state, does have its own hospital—but, like many rural hospitals, it no longer offers obstetrical services, Avery says, so women in labor must travel about 60 miles to Tuscaloosa. When hospital budgets get tight, Avery explains, obstetrical wards are often one of the first things to go.

The problem has metastasized across the state and the nation. In 1980, 45 of Alabama’s 54 rural counties had hospitals providing obstetrical services. Today only 16 of them offer such care, and doctors say that means many, many women need to drive an hour or more to deliver their babies or even get basic prenatal care from an ob–gyn. Too many women cannot make such a long monthly trek, so they simply do without. Others seek care from their family physicians.

Such extreme access problems lead to difficult decisions. Some women in Alabama preemptively choose caesarean section births because they fear they will not make it to the hospital in time, says Dale Quinney, executive director of the Alabama Rural Health Association. Although there have been no studies proving it, Quinney believes the access issue helps explain why his state has one of the country’s highest caesarean rates—35.4 percent of its births in 2015. (The national average was 32 percent that year).

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