New York State has experienced a rise in hospital closures in recent years, especially in rural areas, driven by financial pressures and operational challenges. Most recently, Mount Sinai Health System announced plans to close Beth Israel Hospital, a major Manhattan hospital, by 2025. This has raised significant concerns, with Mayor Eric Adams and others worrying about the impact on New York City’s already overburdened public hospital system, particularly with the influx of migrants in the City.
This article explores how hospital closures across New York State could negatively impact maternal health outcomes and contribute to the persistent racial disparities in maternal mortality. With closures further reducing the availability and accessibility of maternal care, particularly for marginalized communities, it is virtually a certainty that we will see an exacerbation of the disproportionately high risks for complications and death faced by Black mothers, in particular.
Maternal Mortality Statistics
Maternal mortality in the United States is a serious public health issue, and New York State unfortunately reflects many of the national trends. The maternal mortality rate in the U.S. was 23.8 deaths per 100,000 live births in 2020, higher than in other developed countries. In New York, the maternal mortality rate was 22.6 deaths per 100,000 live births in 2019.
These numbers are especially alarming for Black and Hispanic women. The maternal mortality rate for Black women in New York is 53.4 deaths per 100,000 live births, over 3 times higher than for white women at 14.9. Hispanic women in New York also face higher risks, with a maternal mortality rate of 18.8 compared to white women.
Nationally, Black women are 3 times more likely to die from pregnancy-related causes than white women. Racial disparities in maternal health reflect systemic inequities and barriers to quality care that disproportionately impact women of color. Tackling the maternal mortality crisis requires understanding and addressing these racial inequities. Closing access to hospitals will only exacerbate this disparity.
What recourse will the women who are already receiving the poorest outcomes have to safely deliver when obtaining quality medical care is being made exponentially difficult?
Hospital closures are deleterious in many ways:
– Reduce availability/accessibility of services: When hospitals close, especially in rural and underserved areas, it reduces the overall availability and geographic accessibility of maternal healthcare services like prenatal care, delivery, and postpartum care. This makes it much harder for pregnant women to access the care they need.
– Affect low-income and uninsured women: Low-income, uninsured, and underinsured women will be disproportionately affected by hospital closures. They already face barriers to accessing maternal care due to costs, but closures will reduce options and availability of care.
– Increase travel distance: With fewer hospitals, women may need to travel longer distances for prenatal appointments, to give birth, and for postpartum care. This can be a major barrier to accessing timely care.
– Reduce capacity and staffing: Hospital closures often result in lower bed capacity and reduced specialist staff. This will result in longer wait times, more rushed appointments, and reduced expertise/experience caring for mothers.
Evidence shows that inadequate prenatal care is associated with higher rates of maternal morbidity. Additionally, with the believability of Black women being a common issue, a more strained system will likely bring even poorer outcomes for the population due to less competition and oversight on the quality of care.
Hospital closures can have several negative effects on maternal health outcomes. For example, longer travel distances to reach an alternative hospital with obstetric services can lead to dangerous delays in accessing emergency care during labor and delivery. One study found a 27% increase in out-of-hospital births after at least 46 California hospitals have closed or suspended labor and delivery services since 2012.
Furthermore, lower continuity of care has been linked to poor communication and coordination between providers. Women who need to switch healthcare facilities and doctors due to closure are less likely to have their medical history, risk factors, and complications recognized in time. This puts them at greater risk for untreated conditions like pre-eclampsia and hemorrhage.
Finally, several studies show that hospital closures directly correlate with higher severe maternal morbidity rates. One analysis found a 9% increase in life-threatening complications such as eclampsia, sepsis, and shock in counties after losing obstetric services. Overall, the body of evidence clearly demonstrates the variety of ways in which closures can negatively impact maternal health.
Consider the Following
To address the detrimental effects of hospital closures on maternal mortality, New York needs urgent and comprehensive solutions, such as:
– Expanding Medicaid Coverage: Increasing Medicaid eligibility and enrollment for low-income pregnant women will provide greater access to prenatal, delivery, and postpartum care, reducing complications and deaths. Medicaid expansion under the ACA allowed many more women to obtain coverage, but there are still gaps.
– Investing in Health Infrastructure: Funding and resources are needed to strengthen healthcare capacity and quality, particularly in underserved areas, through measures like telehealth access, mobile health clinics, maternity care desert grants, and recruitment of OB/GYNs.
– Improving Maternal Health Data Collection: More consistent, comprehensive, and timely data collection and reporting on maternal deaths and complications is needed to identify problem areas and implement targeted solutions.
– Implementing Best Practices and Recommendations: Increase the scope of the New York Maternal Mortality Review Board and Advisory Council to not only study the causes of maternal mortality deaths and make recommendations to preclude such tragedies, but to implement best practices based on the studies already conducted.
This along with collaborative and coordinated statewide efforts with community-based organizations seeking to prevent maternal deaths, including but not limited to early warning tools, implicit bias training, postpartum protocols, etc. have provided evidence-based recommendations to prevent maternal deaths.
In conclusion, the closures of hospitals across New York State, especially in underserved areas, could have serious implications for maternal mortality and worsen existing racial disparities. While financial and operational challenges have led many hospitals to shut down, the effects on maternal health cannot be ignored.
As discussed, hospital closures can reduce access to vital maternal care, leading to more complications and deaths. This compounds the risks already faced by minority women in New York. There is an urgent need for solutions to preserve and expand maternal health services.
The state must act swiftly to implement recommendations on improving data collection, expanding Medicaid access, upgrading infrastructure, and more. Sustained progress requires continued public engagement.
Helix Strategy Center is dedicated to being a part of the solution to significantly and positively impacting the state of women’s healthcare. Our mission is to develop actionable solutions to social injustices and provide education through research and innovation, specifically as it relates to raising the standard of healthcare for women.
What are your thoughts on hospital closures and maternal mortality? How do you think New York can address this issue? Please share your perspectives below.
References:
New York State Department of Health Releases New Report On Maternal Mortality (ny.gov)
Which NY hospitals will halt elective health care? See the final list (lohud.com)