The battle over access to reproductive health care in this country
is largely focused on abortion. But often overlooked is a dire problem
over where to give birth. In short in many parts of the country,
there are fewer places to do it. Maternity wards are obstetric units
have closed in many states this year, including New Hampshire, New
York, Delaware.
Florida, Mississippi, Texas, Wyoming and more.
At least seven million women of childbearing age live in so called
maternity care desserts here in red. Those are counties with no obstetrics
unit and no birth center. Those are places where midwives independently
oversee delivery.
Earlier this weekend. I spoke with two experts on this issue. Lisa
MacGregor of Harvard University and Aubrey Tompkins, the president
of the American Association of Birth Centers. Thank you both for
joining me, Alicia. Let me start with you What is happening right
now, with the number of facilities that deliver babies in this country,
and how significant is it?
Without a doubt, our system of obstetric care in the country is isn't
a crisis.
Um, when we look at the number of maternity wards that have closed
between 2006 and 2020.
They're in excess of 400 across the country. Some states have higher
rates than others. So places like Pennsylvania, North Dakota, we
see very high rates the hospitals that are most deeply impacted by
maternity ward. Closures tend to be those hospitals that are known
as black serving hospitals or Latino serving hospitals, so they have
a greater share.
Um black and Latino patients than other hospitals. In fact, hospital
care tends to be relatively segregated even to this day, and that
that remains the case for at the hour of childbirth as well.
Aubrey. What about the support on the state level in some of these
more red states? Um, what does that look like with birth centers?
Is there that support or is it not there, So we as a country have
the worst outcomes of any developed nation. Currently, you know,
Alabama and Louisiana that are significantly low on the list. Unfortunately,
a lot of state government agencies like health departments do not
understand. First centers are being educated and informed about
Birth centers from the wrong avenues from
Physicians and hospital systems that don't really understand for
centers, so they're working to put up obstacles and blocks to them.
So we need to have a lot of grassroots movement and education on
the benefits of the birth center model in the midwifery model of
care to improve these outcomes. Want to ask you both?
How does the post role
affect all of this? This area?
One of the things that's important to remember in a post Roe world
is that in this country if you are a black brown, indigenous or person
of color, and you become pregnant, you honestly and truly have to
contemplate that you could die in our country. We have the worst
maternal mortality outcomes of any nation.
Developed nation, particularly for black birthing people. So you
have the honest and true specter of death related to pregnancy. We
have taken away the ability to decide whether or not to be pregnant,
and we are also creating maternity healthcare desserts. Uh, so this
is a crisis in our country that we need to address. We know from
our interviews with
Women in birthing people in to to urban areas in the United States
where we've done this research that people have lost faith in the
system of hospital care that we have. They don't feel safe in the
clinical encounter, especially at such a vulnerable time in life
as that of childbirth.
And so, um, the movement to to start birth centers. There's a movement
to start one in Boston. There couple in Washington D C. I'm hugely
inspired by this movement for more community based models of care.
Uh, I'm inspired by the women in burning people who want to sort
of take
This process this natural process and put it in their own hands because
there's there has to be there has to be another way until we've until
we've deeply reformed the system that we have.
Such an important topic, at least in McGregor and I'll be talking.