Tribal Money

Rural hospitals struggle to provide obstetric care

Rural hospitals are losing money on their midwifery programs, but many are keeping those wings open anyway, according to a recent national survey.

“The needs of local communities were the primary reason and many cited poverty in their communities,” said Katy Backes Kazhimannil, director of the University of Minnesota’s Center for Rural Health Research. She led the rural hospital surveywhose findings were published last month.

Hospital administrators said they needed, on average, 200 births a year to provide safe maternity services and remain financially viable. Yet more than a third of the hospitals that responded to the survey had fewer births than the minimum they needed. And about 20% of respondents said they weren’t sure they would still be providing obstetric care in 10 years.

Backes Kazhimannil said inequality is at the heart of the problem.

“These statistics represent a long-standing underinvestment, primarily in rural, tribal and black communities,” she said.

The survey results also signal, said Backes Kazhimannil, “the need to reinvest in these places and to really take an honest look at the consequences of decades of unhonored treaties, unrealized investments in some of the most vulnerable in our country”. .”

This includes improving access to high quality preconception, maternity and postpartum care.

Respondents acknowledged the serious consequences of the shutdown, such as maternal and child mortality that is more likely to hit families of color — “exponentially more” likely, as a recent study found. CDC data show that black women die from pregnancy-related problems at a rate three times higher than other groups, while indigenous women are twice as likely to die.

Approximately 30% of survey participants operate in the Mountain West region. Backes Kazhimannil says rural communities in the region and beyond face an even broader public health crisis where the challenges of providing maternal and rural health care converge.

This is especially true for indigenous women in the region.

His research has shown that some of the highest rates of serious morbidity and mortality are found among Aboriginal people. “And then it’s even more exacerbated when you look among the indigenous people who are rural residents living in some of our most rural tribal lands, frontier lands and other areas,” she said.

Backes Kazhimannil points to several causes. For one thing, many Indian Health Service facilities do not provide childbirth care, so natives often travel great distances to see doctors. They also often lack support and resources such as access to healthy food and access to jobs.

“The burdens fall disproportionately on the most vulnerable communities, the most remote rural, tribal and border communities, and on rural black and indigenous communities,” Backes Kazhimannil said.

This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Nevada Public Radio, Boise State Public Radio in Idaho, KUNR in Nevada, the O’Connor Center for the Rocky Mountain West in Montana , KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations throughout the region. Funding for the Mountain West News Bureau is provided in part by the public broadcasting company.