Let’s Save the Maternity Units Like We Do the Banks

Maternity units are closing at an alarming rate. What if we thought about maternity care like we thought about extractive, under-regulated, poorly run banks?

Access to obstetric services has been on the decline for years in rural areas: At least 89 obstetrics units in rural U.S. hospitals closed their doors between 2015 and 2019. Today, more than half of rural counties are maternity-care deserts. (Jalaa Marey / AFP via Getty Images)

The United States is experiencing a health crisis that rarely makes it into mainstream headlines: the shuttering of obstetric units in (mostly) rural hospitals across the country. These units are closing at an alarming rate and disproportionately impacting Black and brown women who are already shouldering the heaviest burdens of our broken health system.

The most recent wave of maternity unit closures, or expected closures, is the result of numerous cascading factors. In the post-Dobbs environment, obstetricians and gynecologists are choosing not to work in red states, fearing the inability to provide needed care to their patients amidst an ever growing slate of anti-abortion restrictions, and also not wanting to raise their own families in such a troubling health environment. (Reproductive justice leaders warned us that abortion wasn’t the only one thing that would be lost when Roe was overturned—we should have listened to them.)

The lack of physicians is forcing some units to close all together, forcing women to travel long distances to access basic healthcare. Other units cannot withstand the financial pressure created by shrinking patient bases. And those serving predominantly low-income populations cannot sustain themselves in the face of Medicaid’s low reimbursement rates and high uncompensated care costs. And let’s not forget about healthcare being a patriarchal system that has historically marginalized (often fully ignored or intentionally harmed) women and their health needs

More than half of rural counties in the U.S. do not have obstetric care, a trend that worsened during the pandemic and has only continued to accelerate since. Black and brown women who already faced care shortages, coverage gaps and discrimination in healthcare are shouldering the greatest danger and weight of these changes.

As of 2020, one in four Native American babies (26.7 percent) and one in six Black babies (16.3 percent) were born in areas that are considered maternity care deserts.

Nationwide, one in four Native American women (24.2 percent) and one in five Black women (20.1 percent) did not receive adequate prenatal care in 2020, compared to only one in 10 white women (9.9 percent). 

These trends are contributing to a worsening maternal health landscape for Black and Indigenous women in this country. Even before the pandemic, the United States had the highest maternal mortality rate among its peer countries. It is not a coincidence that the maternal mortality rate has increased 40 percent over the last two years, with Black women seeing the sharpest increases. (That increase rate for Black women in 2021 was 69.9—nearly twice the rate in 2018 and nearly three times that of white women.)

I can’t imagine many things more core to the well-being of our economy and our communities than the health of women, of mothers and the children they bring into this world.

The fact that millions of women are likely to lose Medicaid coverage in the coming months as pandemic-related benefits come to an end will certainly not help these statistics. Black women living in the 10 states that have not expanded Medicaid—states with some of the worst maternal and child health outcomes, and with high rates of hospital closures—will disproportionately be left without health coverage at a time when geographic and legal access to a range of reproductive and sexual health services is rapidly shrinking.  

But what if we thought about maternity care like we thought about extractive, under-regulated, poorly run banks? We have plenty of examples of the federal government quickly mobilizing resources to bail them out. They are indispensable! They are core to the wellbeing of our economy and our communities! They are too big to fail! But I can’t imagine many things more core to the well-being of our economy and our communities than the health of women, of mothers and the children they bring into this world. 

The premise isn’t a foreign one. The U.S. spends millions of dollars every year investing in women’s health in developing countries, with a clear understanding that maternal health—and sexual and reproductive health more broadly—is core to the stability and growth of economies. How can we have thriving communities if mothers are sick and dying from childbirth? If their children can’t access quality healthcare? If they can’t rely on trusted providers who treat them with kindness and respect? 

They can’t. Period. 

The existence and persistence of maternity care deserts isn’t inevitable, it is a choice. Our leaders could decide to view the loss of maternity care as the crisis it is and make different policy choices to address it. Black women lawmakers have given us a roadmap to do just that. 

But the historical devaluation and disregard for Black women’s bodies, labor and lives has made the current crisis—which Black and brown women are feeling most acutely, but which has spilled into poor white communities as well—background noise for many of our political leaders. They clearly don’t feel it’s their responsibility to ensure the health and wellbeing of the women who are the backbone of our economy, our communities, and our families. 

But you can bet if tech bros were facing an escalating crisis in sexual and reproductive health, it would be.

Up next:

U.S. democracy is at a dangerous inflection point—from the demise of abortion rights, to a lack of pay equity and parental leave, to skyrocketing maternal mortality, and attacks on trans health. Left unchecked, these crises will lead to wider gaps in political participation and representation. For 50 years, Ms. has been forging feminist journalism—reporting, rebelling and truth-telling from the front-lines, championing the Equal Rights Amendment, and centering the stories of those most impacted. With all that’s at stake for equality, we are redoubling our commitment for the next 50 years. In turn, we need your help, Support Ms. today with a donation—any amount that is meaningful to you. For as little as $5 each month, you’ll receive the print magazine along with our e-newsletters, action alerts, and invitations to Ms. Studios events and podcasts. We are grateful for your loyalty and ferocity.


Andrea Flynn is the senior fellow of health equity at the Maven Collaborative, where she researches and writes about race, gender, health and economic policy. You can find her on Twitter @dreaflynn7.