What’s the news: Unequal distribution of maternal care. Facility closures. Higher rates of infant deaths. Researchers tracking maternal health care access across Chicago’s ZIP codes have issued a report underscoring the challenges of achieving equitable ob-gyn access in underserved urban areas.
The report—“From Facilities to Outcomes: A Neighborhood-Level Examination of Maternal and Infant Care Access in Chicago” (PDF)—highlights the potential impact of maternity care deserts in urban areas. The report’s authors assessed maternal health care access at a ZIP-code level in Chicago based on three categories: low access, medium access and full access.
A maternal health care access measure combined three variables at the ZIP code level: the ratio of ob-gyns to women of childbearing age (15–44 years old) within a ZIP code; severe maternal morbidity; and a hardship index.
Researchers from the AMA and Sinai Urban Health Institute, with support from the March of Dimes, found unequal distribution of low, moderate and full maternal care access in Chicago. The South and West sides of the city, and ZIP codes representing mostly Black residents, had most of the low-access ZIP codes compared with downtown and the North Side, which harbored the most full-access ZIP codes.
ZIP codes with low maternal care access also overlapped with ZIP codes containing largely Hispanic or Latino populations.
The South and West sides experienced higher rates of infant deaths, preterm births and low birth weights. The report’s authors also found a correlation between areas with high rates of inadequate pre-natal care and areas with few or no registered ob-gyns, and those farther away from hospitals with a high capacity for maternal and infant care.
Facility closures had a big impact on areas scoring highest on the hardship index. Three ob-gyn facilities convenient to South and West side residents all closed within the past six years, forcing expectant mothers to travel outside of their neighborhoods to get ob-gyn care. The number of ob-gyns available to childbearing female residents on the South and West sides of Chicago ranged from zero to 43.
Why it’s important: Maternal health faces ongoing challenges nationwide, despite overall progress in medical science and technology. “In recent years, the U.S. has witnessed a mounting awareness of maternal health inequities, unveiling a complex interplay of socio-economic, racial and health care system factors,” says the report.
More women in the U.S. die from pregnancy-related complications than in any other developed country. There are also deep racial and ethnic inequities in maternal mortality that the federal government can help ameliorate through concrete actions.
“The health of medically disenfranchised patients and the health of their babies suffer when pregnant patients don’t have access to care in their communities,” said AMA President-elect Bobby Mukkamala, MD. “With closures of health care facilities compelling patients to travel for necessary care, patients experience worse health outcomes.”
It also makes it more difficult for these communities to recruit new physicians into specialties such as obstetrics. “This has created a cycle of disjointed, disconnected care for patients in these neighborhoods, a higher level of burnout for physicians and physicians leaving the profession altogether,” said Dr. Mukkamala.
A March of Dimes report, “Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity,” related similar findings on a national scale.
Maternity care is not a priority in the U.S. health care system, said Ashley Thies, senior executive director of the Chicago March of Dimes. “Families in more than one-third of counties in the U.S. have no access to maternity care, putting moms and babies at risk for negative birth outcomes," said Thies.
To increase ob-gyn care to underserved populations, AMA’s report authors urged stepped up usage of telehealth for pregnancy care, building community trust and getting support from community partners, foundations and payers, and diversifying the maternal health care workforce.
Learn more: The AMA is committed to improving maternal health outcomes in the U.S., supporting a variety of strategies to address this crisis.
The AMA has identified 7 keys to improve maternal health care, such as addressing social determinants of health among pregnant or postpartum patients by enhancing medical-legal partnerships, promoting telehealth and home monitoring during pregnancy and postpartum, and providing remote patient care.
