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Where did the OB/GYNs go?

Maternity care deserts are increasing. What can we do?
Where did the OB/GYNs go?
Carlos Cho Ho Fotografia

Prenatal care is essential. But not everybody gets it.

Pregnancy is risky.  OB/GYNs serve a vital role in supporting, educating, and helping people during pregnancy, where they can provide routine screening for serious complications such as preeclampsia and gestational diabetes. Screenings and treatments are done to manage possible complications before they become serious, as a way to lower the rates of early delivery and maternal mortality. 

However, these crucial services are far from being equally accessible.

Dr. Kyle Bukowski, a twice board certified OB/GYN and chief medical officer of Planned Parenthood Maryland described prenatal care as essential. He goes to say, 

“Prenatal care is the most effective strategy for reducing poor neonatal outcomes, so, poor outcomes for babies. This includes for parents, this includes preventing or identifying preeclampsia or high blood pressure conditions that are one of most common reasons that there are poor maternal health outcomes.”

Prenatal care, he explained, can greatly reduce the possibility of premature birth or birth complications for both the offspring and parent.

 Lacking prenatal care can be dangerous and life-threatening, especially in the face of serious complications, as explained in a study by NIH titled Factors associated with lack of prenatal care in a large municipality.  This makes pregnancy particularly risky and dangerous for people who live in maternity care deserts. A maternity care desert is a place where maternity care is lacking or nonexistent. In 2022, in the United States, 34.9% of counties were considered to be maternity care deserts, compared to 45.7% having full access to maternity care, and 20.4% were classified as having moderate or low access to maternity care, as found by March of Dimes. 

In addition, having an accessible provider is incredibly important. Alla Goldberg said, “One other thing that was helpful, [the OB/GYN’s] office was near my work, where my office was and it was also convenient because throughout the pregnancy and especially towards the end of the pregnancy, a patient has to go pretty frequently so it was convenient for me not have to take too much time off of work.”

However, not everyone has a provider that is nearby and readily available. The proliferation of maternity care deserts have led to negative health outcomes across the entirety of the United States. In the 2023 March of Dimes report card, the United States was given a D+ for preterm birth grade due to the outrageously high rate of 10.4%. Additionally, the maternal mortality rate has nearly doubled since 2018. In  2021 there were 32.9 deaths per 100,000 births while in 2018 there were 17.4. As Goldberg explained, location was an important factor when choosing an OB/GYN, and many people are unable to take time off work to go to a clinic that far away.

The most alarming part is that maternity care deserts have only increased since the overturning of Roe v. Wade.

But why is this happening?

The ban of abortion access has greatly increased the number of maternity care deserts. Many maternity care providers leave places with abortion bans from a fear of being accused of committing a crime. They know that if their patient needs a life-saving termination procedure they’d be restricted from doing so. Moreover, those unable to access abortion care have no choice but to carry on their pregnancy, even if it poses numerous risks. 

Dr. Bukowski said, “We know that when abortion becomes inaccessible or severely restricted or banned people who don’t want to continue pregnancy or may be unsafe to continue pregnancy are forced to continue pregnancy and take on all of those risks. Secondly, the ability to access abortion somewhere else or outside of state may be very challenging for them. And we talk about this double-edged sword particularly for abortion bans in places where people have limited resources.”

People who are unable to continue a pregnancy safely or lack economic stability to do so take on a high risk if unable to get an abortion. Dr. Bukowski explains, “So you have somebody who may have limited economic or social resources. So therefore parenting a child or another child may be a more significant burden and so they would want to access abortion but it is not accessible in that state. And these are the states with the poorest maternal health outcomes, or highest risk of dying or having bad outcome in their pregnancy.”

Maternity care and abortion are both most scarce in rural areas. Additionally, the lack of people in rural areas causes professionals to leave due to the lack of income they are receiving for their services. Dr. Bukowski puts it this way,

“[We want] Humanistic people as administrators in hospitals and investors and hedge-funds, business people who wanted to create healthcare systems that are actually focused on quality healthcare, not just generating revenue for CEOs.”

The American healthcare system favors economic success above providing quality healthcare.  Healthcare is now about business rather than humanity. If professionals aren’t making money in rural areas, they tend to leave. This also is contributing to the rising cost of general healthcare as well.

Not only this, but deficits in maternity access have been rooted in systemic racism and sexism due to the many misconceptions and prejudices that healthcare providers have and bring with them to the clinic. This leads to ineffective or inadequate treatment of complications and help offered to certain individuals. The rates of preterm birth in people of color are 1.9 times higher than the national rate, as found by the March of Dimes.

Dr. Bukowski explains, “If we look at a little higher-level than that, it’s very clear when you look at places where abortion bans have been enacted it is prominently…the confederacy…so this is systemic or institutional racism that has existed for centuries in the United States. So that structured power, so that certain groups of people with more resources or economic resources, more social resources, more real estate resources, while other groups of people were left out of power. And they designed the way that legislative state bodies where people were elected to give more power to people who had those resources.”

People who are  experiencing racism in their care are being forced to continue pregnancies that can be are dangerous or unwanted.. The CDC found that Black people are 3 to 4 times more likely to die of pregnancy complications than white people. Many of these complications are avoidable, by taking Black people’s concerns seriously, or having abortion access to people for whom pregnancy can be dangerous. 

Not only this, but sexism continues to be a driving factor in maternity care inadequacies. In the past, the majority of OBs were men, and although now the female to male ratio of OBs is female skewed, the system still has the remnants of male procedures and influence. The male OB would often discourage AFAB’s advocacy in their care. Many pregnant people felt more comfortable going to a female doctor. As Alla Goldberg said,

“I did want to have a female doctor, I just felt more comfortable having a female doctor rather than a male doctor.”

Many novels on pregnancy such as What to Expect When You’re Expecting by Heidi Murkoff tell the readers that they should defer to their doctor, instead of advocating for themselves. They are encouraged to not make decisions about their body and instead listen to outside guidance. Moreover, abortion bans have been a way to control women’s bodies and take away their power in decision making.

Maternity care deserts and lack of access to maternity care has such a huge impact on the US and individuals. But what can you do?

Voting for candidates who support accessible maternal care is one of the most powerful methods to make change in your community. In addition, posting about maternal care and abortion access on social media helps to share knowledge, raise awareness, and make change.

For too long has the government focused on creating sweeping legislation that applies to all of the US. This can lead to smaller areas being overlooked, leading to ineffective and lacking maternity care. We need changes tailored to people’s specific needs to support and empower communities, rather than treating each place the same.  We need to advocate to create individualized change that can help people raise the happy and healthy families that they want and deserve. 

Edited by Dessa Haavik.

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    LalaMay 25, 2024 at 2:04 pm

    This is absolutely incredible. I am being so sincere right now. Thank you for sharing your story. You have been an inspiration.