A 2022 report from the March of Dimes shows that nearly half of the counties in Arkansas qualify as maternity care deserts. That term is defined as a county lacking access to birthing hospitals, birth centers and obstetric clinicians like OB-GYNs or midwives. The report finds that 60% of maternity care deserts in the country are in rural counties. Ozarks at Large's Aiden Dixon reports.
Dr. William Greenfield has spent years working with mothers in Arkansas as a professor of OB-GYN at UAMS and a medical director for family health at the Arkansas Department of Health. He says the challenge facing rural mothers starts with two basic issues.
“In Arkansas, we're talking around 35,000 births per year. And when you look within our state, in terms of where the concentration of providers are, when you get to the rural areas of the state, you can certainly see there are large swaths of the state that may not necessarily have providers who are able to provide delivery services. So one of the challenges that our patients are going to face is simply access to providers, because there's a relatively low number in certain portions of the state. That's one challenge. A second challenge that we would face is the number of delivering hospitals. That number has diminished over the past several years, and that creates a barrier as well.”
Craig Wilson, the CEO of the Arkansas Center for Health Improvement, agrees that these are the relevant issues across a significant portion of Arkansas counties.
“So those are a couple of the components that make up that maternity care desert. We know that as of 2022 there are about 10 Arkansas counties that had no OB-GYNs. And we've lost nine labor and delivery services, or hospitals with labor and delivery services, since 2019. There are more frequently going to be maternity care deserts.”
But Dr. Greenfield says there is an important thing to keep in mind when these closures occur.
“The need for that patient does not necessarily change. And one challenge, I think one thing that has to be considered, is that the patients will see hospitals and hospital systems as a source of help in a time of need. And if someone is not attuned to what the changes are within their system, they may not necessarily know where to go.”
It's the traveling for that important health care that Wilson says the data collected and supplied by ACHI surprised him the most.
“It's not really that surprising, I don't suppose, but we're able to actually quantify the distance that women are traveling over time. So when a hospital stops labor and delivery services, and let's just say, for example, it's in Phillips County, and their median travel time to deliver the baby was, in 2019, six miles. When that goes somewhere close to 40 or 50 miles when that labor and delivery unit closes, we can actually quantify that. And we know from the evidence that for every half mile that they have to travel, it increases the risk for poor outcomes.”
So here's the problem. Simply put, there's a lack of available maternal health care in much of rural Arkansas. So the question then becomes what should mothers faced with the challenges of restricted maternal health care access do?
“Planning in advance becomes of much greater import. If they're high risk, getting closer to a delivering hospital could also be an option for them. But frankly, there are very few options. You just don't know when the baby's going to come. So that's really what presents a challenge. I think modeling something here in the state after what we've done with the trauma system, for moms to be able to know what is available to them very quickly when that time comes, I think that's going to be important. And that's something policymakers are certainly exploring.”
Dr. Greenfield says that from what he can observe he is optimistic about the future of Arkansas.
“We are, I think, at the cusp of having a very good impact on health care for the women and families of our state. In the 20-some-odd years that I've been doing this, I don't think I've seen this broad of an interest or collective effort focused on women's health and improving health care for our patients. We have a number of committees and organizations across the state, ranging from large system-based organizations to community-based organizations, that will have an impact on individual patients. They will have an impact on families and systems. And all of these things together, I think, should help to raise the standard of care and improve the health care outcomes for the patients that we serve.”
Though he says the road to get to that better future isn't cleanly laid out.
“No silver bullets, no magic piece. It is a collective of, in some ways, everything everywhere all at once.”
For Ozarks at Large, I'm Aiden Dixon.
Aiden Dixon is one of our student reporters this year on Ozarks at Large, reporting on maternal and women's health in Arkansas. Support for his reporting comes from the Women's Giving Circle with the University of Arkansas.
Ozarks at Large transcripts are created on a rush deadline and edited for length and clarity. Copy editors utilize AI tools to review work. KUAF does not publish content created by AI. Please reach out to kuafinfo@uark.edu to report an issue. The audio version is the authoritative record of KUAF programming.
