Maternity care deserts should be top priority, especially for pro-lifers

Nearly one-quarter of women in the Equality State live more than 30 miles away from a birthing hospital, making much of Wyoming a “maternity care desert.” 

That leaves many with no choice but to make long, dangerous trips in harsh weather to other communities here or in nearby states. 

Pregnant Rawlins women are now making the 90-minute drive — in good weather — to the Laramie hospital. In Riverton, some women go to Lander, but others seek care in Jackson, Thermopolis, as well as Denver and Salt Lake City. Options for pregnant women in Kemmerer all involve lengthy trips.

It must be a nightmare for expectant mothers to think about giving birth while stuck on a highway. On top of the risk of getting in a car accident and other emergencies, the quality of health care can also be negatively impacted. 

“That long drive [to a birthing hospital] isn’t just an inconvenience. It actually is associated with health risks,” Katy Kozhimannil of the Minnesota Health Research Center explained to CNN. “The consequence that we saw is an increase in preterm births. Preterm birth is the largest risk factor for infant mortality [and] a huge risk factor for developmental and cognitive delays for kids.”

Wyoming isn’t the only state experiencing maternity ward closures. Since 2011, 217 U.S. hospitals have closed their labor and delivery departments, according to a report by Chartis, a healthcare consulting firm.

What’s different about Wyoming is, unlike other states, we’re not doing much to bring resources and solutions to maternity care deserts. I wish I could say Wyoming lawmakers are interested in exploring the issue, but when it comes to birthing babies, the “right-to-life” majority in the Legislature is fixated on its own moral imperative to ban all abortions.

The abortion desert, by the way, encompasses virtually all of Wyoming. Wellspring Health Access in Casper will soon be the last brick-and-mortar clinic in the state that offers elective abortions. The Women’s Health and Family Care clinic in Jackson, which now provides chemical abortions, is scheduled to close its doors on Dec. 15.

The Wyoming Legislature’s decision to ban both surgical and medication abortions earlier this year will force expectant mothers to carry a fetus to full term, if the 9th District Court in Teton County upholds the legislation. Only a lawsuit that’s still being decided by a judge has kept the laws from being enforced. Arguments on the case are scheduled later this month, but whoever loses is expected to appeal to the Wyoming Supreme Court.

No one who is on the pro-choice side of the debate maintains that a woman’s right to have a baby should be infringed on by the state. But the religious-based, right-to-life movement believes it has unfettered freedom to decide what a pregnant woman does with her body. These “pro-birth” zealots are willing to spend any amount of public money to vigorously defend the Legislature’s action. 

The main problem I have with Wyoming lawmakers who lead the so-called “pro-life” movement is that once the baby is born, their interest in its quality of life often takes a nose-dive. I don’t believe one can be pro-life if they are unwilling to go to the mat for maternal and infant health care, and a safety net so impoverished families can keep their kids clothed and well-fed.

This spring, lawmakers voted to extend postpartum Medicaid coverage to women in Wyoming. Many of the bill’s opponents, ironically, happen to be some of the loudest pro-life voices in the Legislature. Gov. Mark Gordon, in contrast, supported the measure, tying it to his pro-life views.

Some legislators take pains to declare they are pro-life before voting to ban abortions, as if that automatically gives them the street cred to claim the moral high ground. Sorry, but it’s irresponsible to think society doesn’t have a much stronger role in supporting the quality of a person’s life past birth.

It takes decisions by lawmakers who support education, affordable housing and a host of other protections for children. It means respecting the right of adults to make their own health care decisions, as enshrined in the Wyoming Constitution.

And it means that instead of limiting women’s rights at all costs, lawmakers should turn their attention to finding ways to keep more OB wards open.

Several states and health care institutions are making inroads that could serve as models for Wyoming. Many hospital administrators told the University of Minnesota’s RHC that they are working to keep OB units open despite low birth rates that have forced closures.

“Of all the folks that we surveyed, about a third of them were still operating, even though they [weren’t economically viable] if they had fewer than 200 births a year,” Kozhimannil said. “We asked why, and they said, ‘Because our community needs it.’”

Now that’s refreshing, and I wish some of that can-do spirit would rub off on Wyoming. Who wants to live in a town that can’t afford to keep an essential health care unit operating? What businesses will view Wyoming as a potential new home if something so basic as protecting mothers and safely delivering babies is out of reach?

One factor that led to the closure of the Rawlins OB ward was the shortage of nurses. Traveling nurses filled gaps, but they made up to three times more than regular nurses and quickly burned through the hospital’s reserve funds.

Wyoming could explore a partnership with other states to train nurses, much like the state did to bring more physicians here when it joined the WWAMI program at the University of Washington Medical School. 

Other suggestions by health care experts include encouraging more telehealth visits for expectant mothers in rural areas, decreasing the number of in-person prenatal care visits and increasing access to care. That would at least keep them off the highway during portions of their pregnancies.

Our state could also promote midwifery services. Certified nurse midwives can assist remote mothers who are high-risk or who decide to give birth at home. Some U.S. communities are considering building freestanding midwife-led birth centers in rural areas.

We have the money to take action. Wyoming socked away a record $1.4 billion into savings earlier this year, and Gov. Mark Gordon is now proposing more than $500 million in additional savings in the upcoming two-year budget cycle. 

Finally, here’s an oldie but still a goodie: expand Medicaid. The March of Dimes has long supported Medicaid expansion as a way to improve access to maternity care.

Wyoming lawmakers have rejected expanding the program since 2013, but it would help hospitals receive reimbursements from Medicaid for an estimated 19,000 low-income adults. Wyoming hospitals wind up eating up to $120 million annually in uncompensated care for patients who can’t afford to pay.

While Medicaid payments are much lower than hospitals receive from private insurance companies, Wyoming could attempt to renegotiate higher reimbursement fees with the Centers for Medicare and Medicaid Services. Barring that, Wyoming has other resources to aid hospitals, including $34 million over the next biennium that the feds have offered as a Medicaid expansion incentive.

Expanding Medicaid would add about 2,000 jobs, mostly in health care. But even if it refuses to expand Medicaid, the Legislature could use a portion of the additional revenues to improve hospitals’ bottom line, and perhaps reopen the three maternity wards or at least keep others from closing. It sure beats an agenda where a “victory” for lawmakers means taking away women’s reproductive rights.