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Insight Into Maternity Care Deserts in Michigan

This article is written by a student writer from the Her Campus at MSU chapter.

A few weeks ago, I watched Dr. Andrea Wendling’s talk on maternity care deserts in rural Michigan, which was recorded on September 23, 2020. In this talk, Dr. Wendling discusses maternity care deserts from a rural family physician’s perspective. She focuses on the barriers faced by pregnant women seeking maternity care in rural areas. In doing so, she analyzes topics such as maternal and infant death rates, access to maternal health care, and quality of care in rural communities compared to urban communities.

Dr. Wendling begins the webinar by highlighting a major consequence of barriers to maternal care in rural areas, saying “Maternal death rates and infant death rates are higher for women in this country who live in rural communities compared to women who live in urban communities” (Wendling, 2020). There are several factors that contribute to these barriers in rural Michigan, including poverty, societal resources, educational resources, transportation to the nearest hospital, and income.

In order to demonstrate how maternity care deserts affect women in rural Michigan, Wendling provides an in-depth discussion on the barriers that these women face to receive maternity care. One such barrier is that rural women may not have a hospital to go to. Over the past 15 years, about 8.5% of US rural hospitals closed mainly as a result of financial constraints (Wendling, 2020). Even if women have access to a hospital within their transportational range, another possible barrier is whether the nearest hospital actually has an OB unit. Over the past 15 years, just as there’s been a trend in decreasing hospitals in rural areas, there’s also been a decrease in labor and delivery units (Wendling, 2020).

Moreover, rural women face the issue of finding access to a physician. There has been a noticeable decrease in rural physicians in recent years. For context, even though about 20% of the US population lives in rural areas, only about 9% of physicians practice in rural communities (Wendling, 2020). Alarmingly, about 40% of rural counties do not have maternity care providers.

The last and most heavily discussed barrier that Wendling highlights is service limitations at rural birthing centers and hospitals. For example, Wendling discusses in detail the special services needed for a woman who has had a C-section in the past. When a woman has had a C-section in the past and is pregnant again, she faces two choices: she can either attempt a Trial of Labor After C-section (TOLAC) or undergo a Repeat Scheduled C-section. If she decides to attempt a TOLAC, it will either result in a successful Vaginal Birth After C-section (VBAC) or Repeat C-section. While a VBAC would result in her not having to undergo surgery, if she chooses to attempt TOLAC, she faces the additional risk that the possible Repeat C-section (if the VBAC were to fail) would occur emergently. This may increase her risk of uterine rupture and other complications (Wendling, 2020). There are many considerations a pregnant woman must make with her physician prior to deciding between TOLAC or undergoing a Repeat Scheduled C-section. Unfortunately, less than half of rural delivery physicians offer TOLACs and VBACs as options available to pregnant women in the US due to staffing issues and other logistics (Wendling, 2020). This decision matrix lays an important foundation for Dr. Wendling’s research, a set up that I found quite alarming.

Upon reflecting on how maternity care deserts could affect rural women, I thought about how decreased access to medical care could affect other aspects of these peoples’ lives. I realized that even if a woman in a rural community has access to care, the stress caused by socioeconomic or racial disparities could also play a role in her health and her baby’s health. For example, Native American women in rural regions are more at risk for issues like poverty and racial injustice compared to white women in these rural regions (Wendling, 2020). I believe that the added stress that these communities face from increased poverty, racial and ethnic disparities, and possibly food deserts depending on where they live can lead to negative effects on their health and the baby’s health. I think legislators who make policy decisions ought to consider these aspects of the maternity care crisis as well.

The government ought to supply more resources to help women gain access to better quality, geographically accessible maternity care, incentivize medical schools to increase the amount of rural matriculants, and possibly provide temporary housing close to rural women’s due dates for women who have to travel for hours to receive maternity care. The maternity death rates in the US are alarmingly high. I know that the government cannot directly fix the racial disparities side of the issue, but it does have the means to fix this rural versus urban disparity.

Hi! My name is Sravani Sunkara, and I am a freshman at Michigan State University studying human biology and bioethics. In my free time, I run, bake, hammock, and volunteer as a junior EMT at my local rescue station.