A recent GoodRx report has unveiled a shocking reality: nearly six million women of childbearing age in the U.S. live more than an hour away from the nearest high-risk pregnancy specialist, creating vast “deserts” of crucial care. This lack of access spells trouble for pregnant women in rural and underserved communities, particularly Black and American Indian/Alaskan Native mothers who already face higher risks of pregnancy complications.
Key findings include:
- High-risk pregnancy specialists are scarce in areas with greater needs, disproportionately affecting vulnerable populations.
- States with the highest maternal mortality rates often lack these specialists, forcing women to travel long distances for vital care.
- Despite these barriers, over 366,000 births occurred in these underserved areas in 2022.
- Women without access to high-risk specialists faced labor complications at more than twice the rate of those who could receive specialized care.
Following the CDC’s recent maternal mortality report, BlackDoctor.org spoke with Karla Robinson, MD, Medical Editor at GoodRx to dive into the far-reaching implications of the GoodRx findings, how these disparities impact maternal health, the challenges of long-distance travel for care, and provide practical advice for women in underserved areas to navigate their pregnancies and secure necessary medical attention.
What are the key implications of the GoodRx report’s findings on access to high-risk pregnancy specialists for women in rural and underserved communities?
Ultimately, there are too few high-risk pregnancy specialists to meet the need for their services in rural and underserved communities.
High-risk pregnancy specialists are typically concentrated in urban areas, but the need for them is often greater in rural and medically underserved communities. Unfortunately, people in rural and underserved communities tend to have higher rates of chronic conditions like heart disease, obesity, and diabetes, which can complicate pregnancies and place more women in a high-risk category. Without access to high-risk pregnancy specialists, women are more likely to face pregnancy and labor complications.
How do the disparities in access to high-risk pregnancy specialists contribute to the disparities in maternal mortality rates, particularly among Black and American Indian/Alaskan Native mothers?
The two are closely linked. Black and American Indian/Alaskan Native women often live in rural or medically underserved areas where access to quality healthcare and resources is limited. And they are also at higher risk for having pre-existing conditions like high blood pressure or diabetes that can complicate pregnancy. Without access to high-risk pregnancy specialists, pregnant women with pre-existing conditions are less likely to be monitored properly and receive comprehensive, effective prenatal care. Plus, Black women are at a greater risk for preeclampsia— a high-risk pregnancy complication that can cause serious illness or death when not diagnosed or treated properly. The lack of access to high-risk pregnancy specialists can result in serious complications during pregnancy and birth for women who have medical conditions while pregnant.
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What are some of the challenges faced by women who have to travel long distances to receive high-risk pregnancy care, and how does this impact their pregnancy outcomes?
The sad reality is that many women who need to travel long distances to receive care may forgo the care altogether due to cost and time constraints. The lack of care can then negatively impact their pregnancy outcomes.
For the nearly six million women of child-bearing living in high-risk pregnancy specialist deserts, it can take on average an hour and 45 minutes to reach a specialized care center. That’s about three and a half hours out of the day for travel. For most people, making time for that journey and appointment would require taking time off of work and/or finding child care – which, for many, comes with a cost. Then, they would have to factor in the cost of gas, if they have access to a car, not to mention the cost of the doctor’s visit itself. Therefore, the cost of travel and care can make it impossible for some women to see a specialist.
For women in rural and underserved areas who may have limited access to high-risk pregnancy specialists, what advice do you have for navigating pregnancy and seeking the necessary care?
If possible, begin prenatal care with an OB/GYN as soon as possible. Even if the healthcare team is not specialized in high-risk pregnancies, consistent prenatal visits can help detect any potential complications or concerns early. If your area is lacking in OB/GYNs, see if there are any health clinics or community health centers in your area that provide pregnancy care. This would be a great first step in at least understanding what your risks may be during pregnancy and what symptoms of pregnancy complications to look out for. Additionally, if you know you have a pre-existing medical condition, make sure you are managing that condition well and following your treatment plan. Making sure you’re as healthy as can be— before and during pregnancy— will help to limit any complications.
What are some signs or symptoms that women should be aware of that might indicate they need to seek high-risk pregnancy care, even if they have to travel a significant distance?
If you have a pre-existing condition like obesity, high blood pressure, coronary heart disease, diabetes, chronic kidney disease, asthma or COPD, you should discuss specialized treatment with your doctor before becoming pregnant or shortly after, if possible. They can help you determine if traveling to seek specialized pregnancy care is right for you. Additionally, women who become pregnant after age 35 should discuss risk factors with their doctor to determine if high-risk care is needed.
Lastly, it’s important to listen to your body while pregnant. If you are experiencing abdominal or chest pain, sudden swelling, vaginal bleeding, extreme fatigue, or other uncharacteristic symptoms, it could be worth seeking high-risk pregnancy care despite the distance.
Are there any resources or support networks available for women in rural and underserved communities who are navigating high-risk pregnancies?
Some communities have rural health clinics with doctors and nurse practitioners on staff who can help support prenatal care. Community Health Centers (CHC) are also a great resource that typically offer prenatal care. CHCs accept insurance but for those who are uninsured, there is a sliding payment scale available based on your income and family size.
What steps can women take to advocate for themselves and ensure they receive the care they need, despite the challenges of living in areas with limited access to high-risk pregnancy specialists?
Understanding your risks and healthcare needs is an important step to being your own health advocate. Resources like GoodRx’s pregnancy guide is an example of trustworthy information available to help you better understand your risk factors, potential complications and what bodily changes to expect throughout the pregnancy process. It’s also important to ask questions. If you develop a new symptom in pregnancy or you’re unsure about your treatment plan, talk to your pregnancy care team. They can help you figure out if you’re at risk for a high-risk pregnancy and if you need to travel to find a specialist.
You should always feel empowered to seek a second opinion if you feel your healthcare needs are not being met by your current pregnancy care team. In some clinics and hospitals, patient advocates are also available to help ensure your needs are being met by your healthcare team.
How can healthcare providers in rural and underserved areas better support women with high-risk pregnancies, given the constraints of their location and resources?
I have found that healthcare professionals in rural and underserved areas are particularly dedicated to their patients and care deeply about their health outcomes. One of the ways that these healthcare professionals help their patients navigate high-risk pregnancies is by sharing additional resources. This can take the form of local resources like free or low-cost health clinics to receive their care, and or other opportunities for saving money on their care. There are also resources they can provide to their patients so that they can still receive high risk consultations and pregnancy monitoring virtually through telehealth options.
Are there any telemedicine or remote monitoring options that women in rural and underserved areas can utilize to stay connected with healthcare providers and monitor their pregnancies?
Yes, telehealth options with remote pregnancy monitoring can help to improve access to high-risk pregnancy care for women in rural or medically underserved areas. This can help to reduce the need for travel and added costs when there isn’t any imaging or specialized testing needed for the visit. Talk with your healthcare team about the possibility for telemedicine and if this may be an option for you.
