How to tell the stories of mothers living in maternity care ‘deserts’

Christine Daniels, a 33-year-old mother from Jasper, a rural north Florida town, had to travel 70 miles round trip for prenatal appointments, and developed preeclampsia going into labor far from home. There is not hospital or emergency room, no obstetric unit in Jasper.

Her 19-year-old daughter, who suffered the dangerous pregnancy complication twice, will travel 136 miles roundtrip to give birth.

And Daniels’ 37-year-old sister, also suffered preeclampsia twice, and each of her five children was born at a hospital at least 30 miles away. 

Help was far away. Stories like Daniels’ and her family echo throughout many communities in rural America that struggle with no obstetric care, and mothers of color like them, who are at higher risk of maternal death and illness, are left with no support.

About 2 million rural women of childbearing age live in maternity care deserts at least 25 miles away from a labor and delivery unit. Across the U.S., half of rural hospitals have no obstetric care.

The federal government only recently began to define the issue. But rural mothers have long suffered higher maternal death rates, yet have less support living in these communities far from hospital-based obstetric units. The U.S. rural health care collapse is not new, yet it’s getting worse.

With support from the USC Center for Health Journalism Impact Fund for Health Equity and Health Systems, I sought to shed light on the lack of maternal health care in the nation’s rural communities, tell mothers’ stories, how the problem has persisted for generations and how the nation’s health care system has failed to support rural communities.

Mothers living in these communities are jeopardized by a dearth of health care safety nets, specifically obstetrics and maternal health.

And for people of color, especially Black and Indigenous moms — as well as Hispanic moms, whose death rates surged in 2020 — suffer the greatest dangers, a product of systemic racism and underinvestment in communities of color. Research shows Black communities have been more likely to lose their obstetric units, despite Black moms being most at risk.

Here are ways to report on the issue in your community and to tell the stories of mothers in the thick of it.

Work to build trust with local mothers and put in the time, approaching them with patience, empathy and sensitivity. Let them know that you want their birthing experiences told, their concerns conveyed and their needs communicated. Be sensitive and gentle, as these experiences often may have been traumatic and taxing. Additionally, if the community is low-income, which these communities often are according to data, mothers’ time and financial resources may be scarce or strapped, and phone calls will not be sufficient to consistently reach them and build rapport. Go back multiple times and spend time with them. To reach mothers in the area, I visited the community frequently to get to know the residents and their neighborhoods, their families, and break down communication barriers.

The nearest hospital doesn’t always tell the full story. There’s a hospital with a maternity ward 35 miles north of Jasper, but most women have to travel 65 miles south one-way for specialized care when they go into labor. I found this out by speaking with multiple mothers and then seeking counts from the local coalition that also showed this. Additionally, check if your local EMS station is understaffed — how many ambulances do they have? Many very rural tribal communities lack EMS entirely. Additionally, many mothers in low-income rural communities may not have reliable transportation, a major barrier to getting to health care.

Don’t assume there’s one plane of inequity. Overall, the nation’s rural maternal death rates are higher than rates in urban counties. In rural counties, research shows Black women have higher rates of maternal death and severe maternal morbidity compared to white moms in rural counties and their Black urban counterparts. In extremely rural counties, Black mothers had about 59 deaths per 100,000 births, far higher that white mothers’ rates of 19.7 deaths per 100,000 births in those same counties, according to an analysis of CDC Pregnancy Mortality Surveillance System data. American Indian and Alaska Native mothers also had higher rates at 37.5 per 100,000 births.

Reach out to local coalitions whose missions are to assist mothers and babies with health and well-being. These groups can be a great starting point to understand the specific maternal health care barriers their clients in these counties face. In Florida, one of those is a nonprofit called the WellFlorida Council, which serves 16 counties and runs the Healthy Start Coalition. Public health officials, including those at local and state health departments, often rely on these coalitions to fill in gaps in health information on local mothers and work closely with understaffed health departments to conduct home visits. Talk with the coalition’s home visitors and program directors.

Seek out hospital data. Try to reach out to the hospitals these women must venture to for delivery and request births by mothers’ ZIP code or county, as well as race and ethnicity to show how many from a specific community must trek the distance to that hospital. Local maternal health coalitions also may keep track of this.

Don’t forget about prenatal care. How many prenatal clinics are available in your county and area of focus? How many per childbearing resident? Talk with experts, mothers and advocates and ask if that number is enough, and if those clinics are understaffed. Can mothers easily obtain an appointment? Do they offer high-risk care, and if not, how far must the mothers referred travel for high-risk care?

How many rural hospitals closed down in your region or state in recent years? Check the University of North Carolina’s rural hospital closure tracker. During the pandemic, two dozen rural hospitals shut down entirely, adding to the steady decline of rural hospital availability over decades, while maternal deaths increased overall. Where are the hospital closures occurring in your state? Are they in Black communities, or communities with higher proportions of people of color? Call the hospitals in your area of focus and ask if they have obstetric units and keep track. The American Hospital Association also conducts these surveys nationally. Dive into U.S. Census ACS data to find how many childbearing people live in the areas lacking hospitals or obstetric units and report the demographics of those now at risk.