Maternity Care Deserts in the US

Sonenberg, Andréa; Mason, Diana J.

doi:10.1001/jamahealthforum.2022.5541

Cited by 17 publications

(12 citation statements)

References 5 publications

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“…If left unaddressed, these maternal care deserts could exacerbate already existing inequalities in maternal health. Hence, policymakers, health care practitioners, and communities must address these gaps and ensure equitable access to high-quality maternal health care . The study did not find statistically significant results for first-trimester pregnancy-related visits and immediate postpartum visits within first 2 weeks.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Severe Maternal Morbidity Among Women Enrolled in Mississippi Medicaid

Maharjan,

Goswami,

Rong

et al. 2024

JAMA Netw Open

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ImportanceMississippi has one of the highest rates of severe maternal morbidity (SMM) in the US, and SMMs have been reported to be more frequent among Medicaid-insured women. A substantial proportion of pregnant women in Mississippi are covered by Medicaid; hence, there is a need to identify potential risk factors for SMM in this population.ObjectiveTo examine the associations of health care access and clinical and sociodemographic characteristics with SMM events among Mississippi Medicaid–enrolled women who had a live birth.Design, Setting, and ParticipantsA nested case-control study was conducted using 2018 to 2021 Mississippi Medicaid administrative claims database. The study included Medicaid beneficiaries aged 12 to 55 years who had a live birth and were continuously enrolled throughout their pregnancy period and 12 months after delivery. Individuals in the case group had SMM events and were matched to controls on their delivery date using incidence density sampling. Data analysis was performed from June to September 2022.ExposureRisk factors examined in the study included sociodemographic factors (age and race), health care access (distance from delivery center, social vulnerability index, and level of maternity care), and clinical factors (maternal comorbidity index, first-trimester pregnancy-related visits, and postpartum care).Main Outcomes and MeasuresThe main outcome of the study was an SMM event. Adjusted odds ratio (aORs) and 95% CIs were calculated using conditional logistic regression.ResultsAmong 13 485 Mississippi Medicaid–enrolled women (mean [SD] age, 25.0 [5.6] years; 8601 [63.8%] Black; 4419 [32.8%] White; 465 [3.4%] other race [American Indian, Asian, Hispanic, multiracial, and unknown]) who had a live birth, 410 (3.0%) were in the case group (mean [SD] age, 26.8 [6.4] years; 289 [70.5%] Black; 112 [27.3%] White; 9 [2.2%] other race) and 820 were in the matched control group (mean [SD] age, 24.9 [5.7] years; 518 [63.2%] Black; 282 [34.4%] White; 20 [2.4%] other race). Black individuals (aOR, 1.44; 95% CI, 1.08-1.93) and those with higher maternal comorbidity index (aOR, 1.27; 95% CI, 1.16-1.40) had higher odds of experiencing SMM compared with White individuals and those with lower maternal comorbidity index, respectively. Likewise, an increase of 100 miles (160 km) in distance between beneficiaries’ residence to the delivery center was associated with higher odds of experiencing SMM (aOR, 1.14; 95% CI, 1.07-1.20).Conclusions and RelevanceThe study findings hold substantial implications for identifying high-risk individuals within Medicaid programs and call for the development of targeted multicomponent, multilevel interventions for improving maternal health outcomes in this highly vulnerable population.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Severe Maternal Morbidity Among Women Enrolled in Mississippi Medicaid

Maharjan,

Goswami,

Rong

et al. 2024

JAMA Netw Open

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“…Nationwide, more than 400 maternity services closed between 2006 and 2020, which left nearly 6 million people with no or limited access to maternity care. 26 Limited access to prenatal and postpartum care increases the risk that health complications will be untreated and creates enormous stress for mothers traveling long distances for care. Strategies to establish access to maternal health care, both in person and by optimizing telehealth coverage to eliminate care deserts, are vital to reduce maternal morbidity and mortality.…”

Section: Limitations To Reproductive Health Carementioning

confidence: 99%

“…Many states have large areas without obstetrical or mental health clinicians (known as maternity care deserts and mental health professional shortage areas). Nationwide, more than 400 maternity services closed between 2006 and 2020, which left nearly 6 million people with no or limited access to maternity care . Limited access to prenatal and postpartum care increases the risk that health complications will be untreated and creates enormous stress for mothers traveling long distances for care.…”

Section: Mechanisms Associated With Maternal Mental Illness That Incr...mentioning

confidence: 99%

Prioritizing Maternal Mental Health in Addressing Morbidity and Mortality

Wisner,

Murphy,

Thomas

2024

JAMA Psychiatry

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ImportanceThe rate of maternal mortality in the United States is 2-fold to 3-fold greater than that in other high-income countries. While many national initiatives have been developed to combat maternal mortality, these efforts often fail to include mental illness.ObjectiveTo highlight the underrecognized contribution of mental illness to maternal mortality, which is nearly double that of postpartum hemorrhage.Evidence ReviewA topic outline was developed to include challenges in measuring perinatal mental conditions and mortality rates; contributions of social determinants of health to mental conditions and mortality; perinatal psychiatric disorder characterization; mechanisms by which maternal mental illness increases mortality, specifically, suicide and addictive disorders; access limitations and care “deserts”; prenatal stress and its impact on reproductive outcomes; increasing clinician expertise through cross-disciplinary education; intervention sites and models; and asserting that mental health is fundamental to maternal health. Publications in the last 3 years were prioritized, particularly those relating to policy. References were selected through consensus. Sources were PubMed, Ovid, direct data published on government websites, and health policy sources such as the Policy Center for Maternal Mental Health.FindingsPriority was given to recent sources. Citations from 2022-2023 numbered 26; within the last 5 years, 14; and historical references, 15. Recommendations to address each topic area serve as concluding statements for each section. To mitigate the contributions of mental illness to the maternal mortality risk, a coordinated effort is required across professional and governmental organizations.Conclusions and RelevanceConcrete programmatic and policy changes are needed to reduce perinatal stress and address trauma, standardize the collection of social determinant of health data among perinatal patients, increase access to reproductive psychiatry curricula among prescribers, reduce perinatal mental health and obstetrical deserts, institute paid parental leave, and support seamless integration of perinatal and behavioral health care. Moreover, instead of focusing on a relatively minor portion of the contributors to health that current medical practice targets, fortifying the social foundation strengthens the prospects for the health of families for our current and future generations.

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“…Adding to the burden of shortage of medical providers in rural communities is the fact that fewer physicians are choosing obstetrics as they specialize in favor of more lucrative medical specialties. Maternity care desert losses are 2-fold, a loss of hospital or birthing center services and a loss of obstetric prenatal care proven to reduce morbidities and mortalities in the community 2 …”

mentioning

confidence: 99%

“…Maternity care desert losses are 2-fold, a loss of hospital or birthing center services and a loss of obstetric prenatal care proven to reduce morbidities and mortalities in the community. 2 "Space and place" gaps referring to urbanism and structural racism contribute to the lack of equitable healthcare experienced by rural and racialized groups. 3 Emerson 4 described a 10% decrease in obstetric services in rural counties from 2004 to 2014, with numbers increasing exponentially in recent years, and a lack of obstetric services currently reported in more than half of all rural counties.…”

mentioning

confidence: 99%

Maternity Deserts

McIntyre,

Ward

2024

Clin Nurse Spec

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Maternity Care Deserts in the US

Abstract: This JAMA Forum discusses community models of perinatal care, workforce challenges, and policies to reduce maternity deserts.

Cited by 17 publications

References 5 publications

Risk Factors for Severe Maternal Morbidity Among Women Enrolled in Mississippi Medicaid

Risk Factors for Severe Maternal Morbidity Among Women Enrolled in Mississippi Medicaid

Prioritizing Maternal Mental Health in Addressing Morbidity and Mortality

Maternity Deserts

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