There is no shortage of statistics or reports showing the lack of reproductive health care, and its effects, in Pennsylvania.
More than 105,000 women between 18-44 years of age have limited or no access to maternity care, Physician General Denise Johnson has said. A study from the Center for Rural Pennsylvania found that 19 counties have hospitals that do not have obstetric services.
And the rate of pregnancy-related deaths in the state in 2021 was 82 deaths per 100,000 births, according to the latest report from the Pennsylvania Maternal Mortality Review Committee.
But those statistics can’t convey what it’s like for someone who is pregnant and lacks access to care.
In Juniata County, it might mean driving almost two hours to get the care that they need.
It’s one of the six Pennsylvania counties classified as a “maternity health desert,” according to a March of Dimes report that came out last year. Those are areas that have no hospitals or birth centers offering obstetric care, or any certified OBGYN providers.
Maggie Leister, a home nurse with Geisinger’s Nurse Family Partnership program in Juniata, often sees patients having transportation issues.
“Some of the clients that we service are pretty young,” Leister said. “The average age is 19 years old. Some of them are out of high school. They might not have their own car yet.”
These patients might have to rely on a family member for rides, or they might have to book a ride with a transportation service, which is not always available when they need it.
For people who live in central Juniata County, travel to the nearest maternity care provider in Mifflin County can be a 25-minute drive. But people who live in the outer edges of the county might decide to go to providers Danville or Harrisburg, which could take from 45 minutes to an hour.
“If there is a bit of an emergency it can take a while to kind of get where they’re needing to go, and even if they would call the ambulance, a lot of places have volunteer services, so it’s not always very speedy,” Leister said.
Patients who have high-risk pregnancies have more challenges, Leister said, because they might have to see a fetal medicine doctor, in addition to their regular OBGYN doctor. The closest fetal medicine doctor is at least an hour and up to 90 minutes away in Hershey or Danville.
Jennifer Conaway, senior manager of home based services at Juniata County Early Childhood Services, has seen mothers with high-risk pregnancies struggle to carve out time to meet with specialists as frequently as they need to.
“They’re just not able to get there because it’s taking a whole day, or they have other kids that are in school that they have to get on and off a bus and they can’t,” Conaway said.
It’s not just prenatal services that are lacking, she said. Parents continue to face barriers post-birth.
“There’s not a lot of pediatricians in the area as well, so a lot of times families will take their kiddos to a doctor’s office that may not necessarily be a pediatrician or specialized in pediatrics,” Conaway said.
One maternal health expert in Chambersburg, an area that is not classified as a maternity care desert by the March of Dimes study, also sees how the lack of maternal care in remote communities impacts her pregnant patients.
Kim Amsley-Camp, a certified nurse midwife at Keystone Health in Franklin County, says about 20% of the patients her clinic serves are from nearby counties, such as Adams, Fulton and Bedford.
Amsley-Camp, who is also a doctor of midwifery student at Thomas Jefferson University, says many of her patients begin their prenatal care late in their pregnancies, because of “institutional barriers,” such as not having health insurance, and having limited access to care where they live.
That kind of delay increases the likelihood of medical complications such as preterm birth, low birth weight, maternal and neonatal death. There are other repercussions.
“After 20 weeks, they get social services interaction, because they want to make sure the baby is safe and what’s going on. What’s going on is the woman just couldn’t get here,” Amsley-Camp said.
Also, not having a place nearby to deliver can leave pregnant patients in precarious situations.
“They risk it. You know, they just get in the car, and they have delivered in the car. One girl delivered twins in her driveway,” Amsley-Camp said. “These women are the most resilient women I’ve ever seen in my life.”
Keystone Health offers OBGYN care and, according to Amsley-Camp, her practice serves anywhere between 80 and 100 patients a month. Despite having so many patients, the clinic has been losing doctors. Before COVID-19, there were five physicians and three midwives; now there are two doctors and seven midwives.
Amsley-Camp suggests some solutions for tackling maternal health deserts are programs to incentivize OBGYNs to work in rural communities, and increasing telehealth services.
A study from the U.S. Government Accountability Office shows that the closure of obstetric wards in rural hospitals has been a problem for over a decade. Some of the main contributing factors are state Medicaid reimbursement rates not covering the full cost of obstetric services, and challenges with retaining maternal health providers in the area. The American Hospital Association found that by 2020, almost half of rural hospitals in the U.S. did not offer obstetric services. The problem of maternity ward closures accelerated during the COVID-19 pandemic, Vox reported.
In March, Democratic state House majority leaders declared maternal mortality a top concern. State Sen. Judy Schwank, D-Berks, introduced a bill to extend Medicare services for doula services. Reps. Eddie Day Pashinski, D-Luzerne, and Jennifer O’Mara, D-Delaware, re-introduced a bill that would make it more difficult for hospitals to close, which could help address one of the root causes for maternity health deserts.
And Gov. Josh Shapiro's proposed a spending plan for the new fiscal year that would allocate $2.3 million dollars to expand maternal health programs to focus on strategies to prevent mothers dying during childbirth.
