Colorado faces unique challenges with rural maternal health, particularly in underserved areas where expectant mothers encounter significant hurdles. Factors contributing to maternal health deserts in Colorado include:

• Geographic isolation: Living in rural areas in Colorado, where health care facilities are limited, poses significant challenges for expectant mothers. Long distances to health care providers can delay or even deter women from seeking the care they need. Forty percent of Colorado counties are considered maternity care deserts, and 10 percent have low or moderate access.¹

• Closure of labor and delivery units: The decreasing number of labor and delivery units across the nation and in Colorado has made it harder for patients to seek care in their own community. Due to factors such as low volume and under reimbursement, some rural hospitals have had to make the difficult decision to close their labor and delivery units to preserve care in other parts of the hospital.

• Health care workforce shortages: In some areas, a shortage of health care professionals like obstetricians and midwives makes it difficult for women to access specialized maternal care. From 2021-22, rural counties in Colorado had less than half as many obstetric providers per 100,000 births as compared to urban counties (3.95 vs. 9.61 per 100,000 births, respectively.²)

Socioeconomic disparities: Lower-income communities often face limited access to health care resources, exacerbating the health disparities faced by expectant mothers.

Understanding Rural Maternal Health Opportunities through Clinical Data

Colorado Hospital Association collects hospital claims data to analyze and monitor health care trends over time and geography. The Association’s data program enabled the study of maternal health utilization from 2017-22, which was the most UpToDate dataset available at the time. The data revealed that Medicaid covered 50 percent of rural deliveries, while commercial payers accounted for 46 percent. By analyzing claims data, the Association was also able to calculate the distance traveled by expectant mothers to deliver their babies. The analysis showed that an increasing number of patients from rural areas are traveling to urban areas to deliver babies. This aligns with the national trend indicating that maternal health deserts are growing, creating equity concerns for rural mothers. Moreover, the Association matched the claims data with risk scoring methodology from Unite Us to demonstrate that rural expectant mothers are at a higher risk for health-related social challenges such as food and financial insecurity, loneliness, utility needs, and transportation.

The Impact on Maternal and Infant Health

Maternal health deserts can have dire consequences for both the mother and the newborn, leading to higher rates of infant and maternal mortality, preterm births, and other adverse outcomes. Inadequate access to prenatal care, education, and support can result in untreated health conditions, complications during childbirth, and increased stress and anxiety for pregnant women. According to the 2022 March of Dimes report, birthing persons in maternity care deserts are more likely to suffer from asthma, hypertension, and tobacco use as compared to women in counties with full access to maternity care services. Furthermore, pregnant women in rural areas face an increased risk of childbirth complications, with rural hospitals reporting higher rates of hemorrhage and blood transfusions as compared to their urban counterparts.¹

Bridging the Gap: What Can Be Done?

Improving maternal health in rural areas of Colorado requires a multi-pronged approach. It includes implementing telehealth solutions to provide prenatal and postnatal care virtually, community outreach programs to educate and support expectant mothers, and fair Medicaid reimbursement rates to support hospitals in keeping their labor and delivery units open. Additionally, incentivizing health care professionals to practice in underserved areas, expanding training of maternal health providers, expanding postpartum care and improved transportation options, can help reduce maternal health disparities. With these comprehensive efforts, Colorado can take significant steps toward ensuring access to quality care for every expectant mother and addressing the critical issue of maternal health deserts in the state.

References:

1. Brigance, C., Lucas R., Jones, E., Davis, A., Oinuma, M., Mishkin, K. and Henderson, Z. (2022). Nowhere to Go: Maternity Care Deserts Across the U.S. (Report No. 3). March of Dimes. https://www.marchofdimes.org/research/maternity-care-deserts-report.aspx
2. Data downloaded from: .S. Health Resources and Services Administration (HRSA), Area Health Resources Files, 2021-2022
3. David C. Radley et al., The Commonwealth Fund 2023 Scorecard on State Health System Performance: Americans’ Health Declines and Access to Reproductive Care Shrinks, But States Have Options (Commonwealth Fund, June 2023). https://doi.org/10.26099/fcas-cd24