On May 31, ACOG submitted a comment letter to the Centers for Medicare & Medicaid Services (CMS) as a response to the Request for Information Regarding Rural Maternal and Infant Health Care in Rural Communities.
Access to obstetric-gynecologic care in rural communities is declining. Rural women experience poorer health outcomes and have less access to care than their urban counterparts. The U.S. is the only well-resourced nation with a maternal mortality rate on the rise, with stark racial and ethnic disparities in maternal mortality, especially for Black women and American Indian and Alaska Native women. Eight percent of the rural population is made up of Black Americans, and of the 5.2 million people who identify as indigenous, 40% live in rural areas on and off tribal lands.
Between 2004 and 2014, approximately 179 rural counties lost hospital-based obstetric services, resulting in a 9% increase from 45% to 54% of rural counties without hospital-based obstetric services. Additionally, more than half of rural women live more than a 30-minute drive to the nearest hospital offering perinatal services. These realities have resulted in increased numbers of out-of-hospital births, births in hospitals without an obstetric unit, and preterm births as well as higher rates of delayed prenatal care, pregnancy-related hospitalizations, low birth weight infants, and infant mortality. To further confound rural access, the obstetrician-gynecologist professional workforce is experiencing a physician shortage and maldistribution, which disproportionately impacts rural areas. Approximately half of counties in the U.S. do not have a single obstetrician-gynecologist.
In the letter sent to CMS, ACOG addressed each of these important issues, seeking to expand access, increase quality, and improve outcomes for maternal health in rural communities, as well as ways to improve and support the rural obstetrician-gynecologist workforce. Among the topics discussed were gaps in insurance access, telehealth, reimbursement, administrative burden, payment and delivery models, Alliance for Innovation on Maternal Health, and social determinants of health.
ACOG will continue advocating for safe, quality health care for rural women across the U.S., while working to strengthen policies and improve reforms that will benefit the rural obstetrician-gynecologist workforce in the country.