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:
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.
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.
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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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.
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.
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.
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.
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.
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.
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.
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