Why you should care
Because the saying is true: It takes a village.
Ashlynn DeMolet’s birth, at 2:51 p.m. on Aug. 27, was a bittersweet moment for the Calais Regional Hospital in Washington County, Maine. She was its last delivery. Two days later, in what the hospital called “the end of an era,” the obstetrics unit closed.
Calais Regional Hospital’s decision to end obstetric services left the county with one other OB unit: the Down East Community Hospital, 40 miles to the south. That’s still better than most rural counties — more than 50 percent now have no such services — but it follows a trend across the nation of rural health care services cutting back on obstetrics:
Nine percent of rural U.S. counties lost all hospital obstetric services due to hospital and obstetric-unit closures from 2004 to 2014.
According to the study, published in September in the journal Health Affairs, limiting obstetric services has “exacerbated concerns about access to care for more than 28 million women” in rural America. From 2004 to 2014, the number of counties without hospital obstetric services increased from 45 percent to 54 percent.
The trend, according to the study’s author Peiyin Hung, stems from three major factors. The first is a lack of staffing, since recruiting and retaining doctors and nurses is more challenging in rural areas. The second is a low volume of births. Calais Regional Hospital, for example, cited a decrease in annual births as one reason for closing its obstetrics unit. The third is financial drain. When hospitals are being pinched financially, “the first thing they think of to stop providing [is] obstetrics,” says Joan Coffman, CEO of St. Mary’s Hospital in Decatur, Illinois.
The Rural Wisconsin Health Cooperative allows independent hospitals to participate in a system of care that lets them share resources.
But hospitals are experimenting with different ways to create models for improving rural health care. For instance, the Rural Wisconsin Health Cooperative allows independent hospitals to participate in a system of care that lets them share resources. By partnering “with others you not only create power, but it’s power for the right reasons,” Coffman says. “It’s purchasing power. It’s the ability to raise the quality of life or quality indicators.” Increasing collaboration among rural health care centers, such as sharing physicians and conferring about treatment, could improve access, Hung says.
One emerging solution is technology. Christina Mullins, director of the West Virginia Department of Health and Human Resources Office of Maternal, Child and Family Health, says transportation is the most overwhelming barrier West Virginia faces. Telemedicine, she says, could improve access to maternity services, as could relying more on health care providers outside hospitals, such as federally qualified health centers and midlevel health providers.
Other countries are also working to address similar challenges. India, for example, created the Accredited Social Health Activist program to improve access to rural health care. One “intriguing possibility for the future” is outfitting ASHA workers with smartphones and portable medical devices so that they can screen for certain health problems, says Abram Wagner, research fellow at the University of Michigan School of Public Health’s Department of Epidemiology, who has looked at the effectiveness of ASHA in improving health outcomes. “The goal would be to identify populations in need of health care with more precise methods,” he explains.
So while this country is in a stalemate over how to structure the foundation of its health care system, those on the ground are pioneering programs that rely on collaboration and connection to bring health care to those who need it.