Where You Live Matters

How North Carolina's Families Are Impacted by America's Maternal and Infant Health Crisis

By: Michaela Penix, MPH | August 2023

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This is a guest post from Michaela Penix, the North Carolina Director of Maternal Infant Health for the March of Dimes. At NC Child we work to ensure that every child has the opportunity to thrive, and that begins with birth. Stay tuned for future blog posts from staff and guests as we highlight the issues affecting our kids and advocate for positive solutions.

In the United States today, a person’s ability to have a safe pregnancy and birth is in jeopardy. Recently, March of Dimes released Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity, a new set of reports that brings the stark reality into sharp focus with state-by-state data showing declining conditions for healthy pregnancies and healthy births for millions of women across the United States.

Nationwide, areas with limited or no access to maternal care affect up to 5.6 million women.  Furthermore, more than 32 million reproductive-age women are vulnerable to poor health outcomes due to lack of access to reproductive healthcare services like family planning clinics and skilled birth attendants. Beyond distance to care, community factors like neighborhood safety, socioeconomic factors, and prevalence of chronic conditions impact pregnancy and birth outcomes. In fact, 80% of maternity care deserts- areas with no birthing facilities or providers giving obstetric care- face a higher burden of chronic illness, creating added dangers for birthing women and their babies in underserved communities.

These numbers are staggering, but the data around conditions here in North Carolina truly drive home the issue for me. Here in North Carolina:

  • 40 counties meet the criteria to be classified as a maternity care desert or low-access to care county,
  • there was a 1.9% decrease in the number of birthing hospitals between 2020 and 2019,
  • 3,573 babies born in maternity care deserts, which is 3.0% of all births, and,
  • 3.3% of babies were born to women who live in rural counties, while 1.5% of maternity care providers practice in rural counties in North Carolina.

When we look at how we fare in comparison to the country as a whole, roughly 13.4% of families in North Carolina have no birthing hospital within 30 minutes of their home, compared to the 9.7% in the US. But what is most sobering to me is that in some rural areas of our state, families are traveling upwards of an hour to give birth. And quite frankly, we should not be comfortable with that reality.

Issues like low birth volume, staff recruitment and retention, and rising costs have exacerbated problems at hospitals nationwide, but I would be remiss if I did not raise the critical issue of activating Medicaid Expansion in North Carolina. We made amazing strides with passing the legislation to support our citizens before, during, and after pregnancy this spring. This legislation will, in turn, absolutely improve overall health and birth outcomes in our state. In addition to the core issue of supporting improved individual health coverage for our citizens, the $1 billion Medicaid Expansion bonus could certainly be used to ensure that North Carolina citizens are not forced to drive nearly an hour to deliver their baby in a medical facility.

We must do more for families in North Carolina and across the country. Having a healthy pregnancy and healthy birth should not be dictated by where you live. Unfortunately, this new report shows that isn’t the case.

March of Dimes is continuing to fight for the health of all moms and babies – through research, funding innovations, advocating for change, convening leaders, and supporting programs that provide education and action nationwide. Here in North Carolina, we continue to raise awareness around the importance of supporting the health and wellness of individuals before they become pregnant through our longstanding partnership with the NC Division of Public Health through the Ready for Life NC program. This program evolved from tackling our serious issue of North Carolina babies born with a neural tube birth defect to now working to ensure that every person giving birth in North Carolina does so in their best possible health. We have been able to collaboratively reduce those incidences of neural tube birth defects by 40% over our 20-year partnership, and we are confident that our legislators, health leaders, and communities will rise together again to tackle this issue of access to maternity care.

Again, these actions are key steps forward, but it will take all of us working together to effect real change for North Carolina families, and for families nationwide.

Let’s have the Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity
set of reports serve as a catalyst – the first step in educating ourselves about the unique challenges facing moms and babies in our communities- so that we can act by bringing awareness and education to others, advocating for change, forging new partnerships, and giving of our time, talent and treasure to make a difference.

Everyone deserves the best shot at a healthy start in life. It’s up to us to help ensure that for families in North Carolina.