As the conversation about health care increasingly includes rural areas, the topic of maternal health is showing up in more places, too.
This past week, South Bend, Indiana Mayor Pete Buttigieg released a health care plan targeted at rural America. In it are several provisions that provide increased support for pregnant and postpartum women.
“It’s time to usher in a new era for rural America,” the plan reads. “That work begins by deploying investment and innovation to secure the health of all rural residents.”
First off, Buttigieg plans to address the problem of declining numbers of providers for all kinds of services by incentivizing physicians to work in these areas.
According to a 2017 American College of Obstetricians and Gynecologists study, which is cited in Buttigieg’s plan, 49 percent of counties in the United States lacked OB-GYNs. The study shows that most of those counties are rural and predominantly in the Midwest and Mountain West.
Earlier this month, a hospital in Marshalltown announced the closure of its birthing center because of the cost to operate. The obstetrics unit and women’s health clinic will close in September, leaving the closest birthing centers 30 to 42 miles away.
According to the same Des Moines Register report, the closure is also caused by a shortage of OB-GYNs.
To combat the problem, Buttigieg’s plan calls for expanding the Public Service Loan Forgiveness Program to include employment in rural private hospitals and practicing groups and change the rate of loan forgiveness.
He also wants to encourage immigrant doctors to work in rural and tribal communities, increase Medicare and Medicaid reimbursement rates for providers in these areas, expand funding for training that incentivizes medical students to work in underserved areas and expand paramedicine programs that would extend the role of emergency medical service providers so they can assist with preventative and primary care.
Buttigieg’s plan also addresses maternal mortality, an issue that’s been gaining attention from the candidates.
The plan calls, in part, for confronting the closure of obstetric units by changing the way providers are paid that considers the smaller number of patients in rural areas.
“The maternal mortality crisis facing America is particularly dire in rural areas, where moms are 60% more likely to die during or after labor than in American cities,” the plan reads. “This disparity is made even more dangerous for rural women of color: Black and Native moms are over three times more likely to die during pregnancy than white women.”
The American College of Obstetricians and Gynecologists cites pay as one of the barriers to practice. They wrote, “The total annual compensation for general OB-GYNs is among the lowest of the surgical specialties.”
Sens. Kirsten Gillibrand, Cory Booker, Kamala Harris, Bernie Sanders and Elizabeth Warren have either sponsored or supported a variety of bills in Congress that aim to solve the issue of maternal mortality in America. Those include the rural MOMS Act, the MOMMA Act, Maternal CARE Act, MOMS Act and MOMMIES Act.
Buttigieg’s plan also calls for ensuring coverage for full reproductive health care and family planning services by increasing Title X funding, Medicaid expansion and benefits provided by the Affordable Care Act.
This includes restoring Planned Parenthood’s funding and reversing the gag rule.
The last piece for supporting pregnant women is to fund models of care that offer transportation and housing for places like pre-maternity homes, where pregnant women near-term can stay before they give birth, to ensure they’re near a hospital when they go into labor.
And because women of color are more likely to die as a result of pregnancy or delivery, Buttigieg’s plan includes a section about addressing the economic and social issues that cause mortality like food insecurity, support for pregnant women and lack of general health care.
His plan proposes to solve these problems through actions like supporting healthcare infrastructure and funding across the board, as well as encouraging Medicare and Medicaid to reimburse community-based ideas.
“Freedom means having access to health care wherever you live,” Buttigieg said in an email. “That’s especially true for an expecting mother who is forced to drive hours to meet with an OB-GYN.”
by Nikoel Hytrek