*This post was originally published in February of 2021. It has been updated to reflect the most recent available data on maternity care access.
The term “desert” calls to mind geographic isolation — a place far removed from society and economic infrastructure. And when it comes to maternity care deserts in rural populations, that image is not far removed from reality.
It’s no secret that distance and socio-economic risk contribute to the high rate of maternal deaths in the US. Many women lack immediate access to necessary care, and don’t have the means or the time to travel to distant providers. This problem is pervasive in rural areas — but it doesn’t stop there. Many of the country’s maternity care deserts are not geographically isolated at all, but exist in the heart of its most densely populated areas.
Barriers of access to maternity care are deeply rooted in social determinants of health: problems stemming from income and racial inequality that transcend the urban/rural divide.
In Washington DC, the absence of care centers east of the Anacostia river (where 38% of the population is below the poverty line) spurred The Atlantic to title it a “maternity desert.” Faced with the problems of distance, accessibility, and socio-economic risk, many women forego prenatal care altogether.
Despite steps that have been taken, including the passage of the DC Council’s Postpartum Care Expansion Act, mothers in DC are still dying at a rate of 44/100k live births, nearly twice that of the already shockingly high national average.
It’s a somewhat misleading statistic — for white women in the District, the chances for a safe delivery are high. It’s mothers of color who are the most frequent victims of these statistics: Black women account for 90% of pregnancy-related deaths. Change cannot happen fast enough for these mothers.
Technology is an obvious step toward a solution. With healthcare professionals reevaluating the benefits and risks of digital health in the wake of the Covid-19 pandemic, the industry is facing its greatest opportunity to override the traditional challenges to the widespread adoption of technology for maternity care.
In the US, healthcare has been traditionally considered a triage machine — a last ditch solution when a patient is on the brink of disaster. On the clinical end, there is a notorious wariness of disruptive technology and workflow changes. During Covid, these mindsets were overturned as clinicians and patients adapted to new methods of receiving and delivering care.
Policy-makers threw their weight behind digital health as they looked for ways to maintain and encourage health management during social distancing and other pandemic responses, increasing physicians’ ability to innovate and transform care models, but many of these pandemic era responses are being rolled back now that the public health emergency has ended.
In response, the Black Maternal Health Caucus re-introduced the Momnibus Act, a historic bipartisan legislative package that builds on existing legislation in Congress to address America’s maternal health crisis for Black women and mothers of color. The Momnibus Act includes the Tech to Save Moms Act, which promotes digital innovation to improve maternal health outcomes and end disparities in underserved communities.
Increased reimbursement from commercial payers and Medicaid have also incentivized providers to transform their practices and increase access to care through RPM (remote patient monitoring).
There are still challenges, of course. Commitment to archaic Electronic Medical Records (EMRs), and the sunk cost of eliminating paper records, have slowed the progress of digital transformation. And that doesn’t even touch on the challenges of interoperability. Policy-makers have to demand that data houses share data in a more scalable and accessible manner to work toward a solution. There is also concern that technology may increase the disparity instead of bridging the gap.