The Rural MOMS Act: Reducing Maternal Mortality and Increasing Care

Sixty-two million Americans live in rural areas, where access to necessary health services is more limited. The number of rural hospitals without an obstetrics unit or any obstetrics care is growing at an alarming rate, placing expecting mothers at risk. Yet, 18 million reproductive-age women live in rural communities across the United States, and half a million babies are born in rural hospitals every year.

According to research from The University of Minnesota Rural Health Research Center (UMNRHRC), which is funded by the Federal Office of Rural Health Policy (FORHP), more than 200 rural maternity wards closed between 2004-2014. Further research showed that today, 54% of rural counties have no hospital-based obstetrics services, and the most vulnerable communities – those who are low-income, minority, more remote – experience the most damaging impact. Rural counties with higher percentages of African American women were more than 10 times as likely as rural counties with higher percentages of white women to have never had hospital-based obstetric services and more than 4 times as likely to have lost obstetric services between 2004-2014.

Distance to maternity care is directly correlated with outcomes, meaning this care shortage has a devastating effect on the health of both the mother and the infant. A growing number of rural babies are being born outside of hospitals or in hospitals without obstetrics care, and infant mortality rates are rising. Rural hospitals provide excellent care for mothers and babies when they have the resources and opportunities necessary, however too many rural communities lose maternity care as the result of multiple factors including: workforce shortages, low birth volumes, and stingy Medicaid programs.

The Rural MOMS Act
Last week, Senator Heidi Heitkamp (D-ND) introduced S. 3568, the Rural Maternal and Obstetric Modernization of Services (MOMS) Act, continuing her commitment to reducing maternal mortality. This bill begins to address the needs of expecting mothers and babies in rural areas to ensure a healthy and vibrant future for rural families.

Improving Rural Maternal and Obstetric Health Data
In order to craft good policy to solve these challenges, we need to continue to develop strong data. The legislation authorizes the Department of Health and Human Services (HHS) Secretary, to “expand, intensify, and coordinate” activities that address maternal mortality and morbidity at the Centers for Disease Control (CDC). This research should focus on improving maternal mortality and morbidity data surveillance to include the relationship between the presence of obstetric services in rural areas and outcomes in delivery and post-partum care.

The bill also directs the Government Accountability Office (GAO) to issue a report on maternal care, including pre- and postnatal care, in rural areas.

Rural Obstetric Health Collaborative Improvement and Innovation Networks (CoIINs)
The bill would create Collaborative Improvement and Innovation Networks (CoIINs), focused on infant and maternal mortality and morbidity in rural areas. The purpose of CoIINs will be to support rural providers and women in rural areas as they work to find “maternal and obstetric care, identify successful delivery models, develop collaborative networks, provide training and guidance to rural health facilities, and collaborate with regional experts at academic institutions.” The bill would allow for the development of 5 regions, including Indian Tribes and frontier areas, in the first year of implantation.

Improving Access and Addressing Workforce Needs
The bill also helps to better develop the telehealth network and telehealth resource centers grant programs through the Health Resources and Service Administration (HRSA) to include maternal and obstetric care providers in telehealth networks. The bill updates the preferences and funding requirements for the relevant grants to enable providers focusing on maternal care.

Further, the bill begins a demonstration program that gives grants to training of maternity care providers in rural areas and develops resident programs or fellowships to include rural obstetric tracks for obstetric and family physicians. Finally, the bill works to improve existing programs to include rural specific obstetric training for physicians, physician assistants, nurse practitioners, nurses, nurse midwives, and doulas
 
The health and safety of women and babies in rural areas is being impacted by a lack of access to maternity care. It is time to take action to reduce maternal and infant mortality, address maternity care workforce shortages, and increase options for care. The Rural MOMS Act will propel us forward to finally begin addressing these needs.

To read the full release from Senator Heitkamp, visit her website here

Comments

Bruce Roesler

The CAH program cost-reporting process basically penalizes CAHs that maintain OB services, contributing to the creation of maternity-care deserts.

  • 10/25/2018 4:55:44 PM

Knesha Rose-Davison

This alarming, "more than 200 rural maternity wards closed between 2004-2014." I think a policy response is certainly needed to help redirect funding and help those in rural areas. I will be following the Rural MOM Act and hopeful that it can deliver on the promise of better health outcomes for moms and babies.

  • 10/18/2018 5:26:46 PM


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