Maternity Care Deserts

Demographic and economic pressures forcing hospitals to cut back on obstetric care

Ric Edelman: It's Wednesday, May 1st. On today's show, the future of maternity wards. China's hospitals are closing their units that deliver babies. This is because the birth rate in China is falling. There just isn't as much need for maternity wards anymore compared to geriatric departments. China's population fell in 2023 for the second year in a row. There are now 4 million fewer people in China than two years ago. This is the first time the population has declined since 1961. Births in China fell 6% last year.  

This problem all started in 1980 when China created that stupid one child policy for families. Back then, China was worried about a population explosion. Yeah, they solved that problem, but now they've created an even worse problem for themselves. They now let couples have three children, but these people who grew up as single kids. They don't have any desire to have two or three children. They're also living in an era where raising kids is more expensive than ever, and they don't want to be saddled with that cost. And women in China now have more economic freedom than ever. Not only do they not want kids, a lot of them don't even want husbands. In 2013, there were 14 million weddings in China. Last year, there were only 6 million. Government data shows that Chinese people are getting married later, divorcing more often, and simply choosing to remain single. 

The result of all this? Hospitals throughout China are closing their obstetrics and gynecological services. They're cutting hours that these departments are open, including eliminating nighttime services. Aren't you glad you don't live in China? Well, guess why I'm talking about this? Because it's happening here in the US as well. In the past 15 years, 217 hospitals across the United States have closed their maternity wards. 13 in the last year alone. And now, 36% US counties have no maternity care services for women and babies. We're talking about pregnant women not being able to find help with delivery or perinatal care, which is medical care before and after delivery, or lactation specialists, or private delivery rooms. 

According to a new report, the states with the highest loss of access are Minnesota, Texas, Iowa, Kansas, and Wisconsin. The March of Dimes says 2.2 million women of childbearing age across more than 1,100 counties are living in what it calls a maternity care desert. These counties have no hospitals that offer obstetric care. There are no birth centers. There are no obstetric providers. And you know the reason for this. It's not just women having fewer babies. It's about money. Two in five births are paid by Medicaid. That only pays 6,500 for a delivery. Private insurance pays more than twice that. So hospitals are saying they simply can't afford to provide maternity services. And forget about neonatal intensive care units. It takes 200 births a year for an obstetrics department to be financially viable in a hospital. And if you have such few births, we're talking only about four a week, you can't hire doctors and nurses. They'd be bored with not much to do. You wait two days for the next baby to come. 

So add it all up. Fewer babies, less money when you're serving them, and the inability to hire doctors and nurses to care for them. The result, maternity wards are closing. And guess what? The maternity death rate is rising. It's now 33 deaths per a hundred thousand births. Four years ago it was 24. All this is showing us the future, fewer babies, and for the mothers who produce them, higher costs, higher risks for themselves and their babies. 

On tomorrow's show, we're going to lighten it up a little and look at the lifestyles of the rich. 

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