Federal action needed to halt maternity ward closures, says expert

March 31, 2023 – As maternity wards continue to close around the country, some states are implementing “bold and innovative” solutions—though none that will be as effective as federal intervention, according to Harvard T.H. Chan School of Public Health’s Alecia McGregor.

In a March 22 interview on The Wheelhouse, a podcast from Connecticut Public Radio, McGregor, assistant professor of health policy and politics, praised Connecticut Gov. Ned Lamont’s plan for new midwife- and doula-led freestanding birth centers to fill gaps in care caused by hospital maternity ward closures.

“Countries like France, the U.K., and Australia have maternal care workforces that are largely made up of midwives, and they have much better outcomes than us. So this might actually bode well for maternal health outcomes in general,” McGregor said.

Nonetheless, the intersecting crises of maternity ward closures, maternal health care inequities, and high maternal mortality rates loom large across the nation and necessitate federal action, said McGregor. She explained that maternity wards are often considered by hospitals to be “money losers,” and are therefore vulnerable to closure, because of how reliant they are on payments from Medicaid, which reimburses at lower rates than commercial insurers.

“This is also one of the reasons [maternity wards] are more likely to close in low-income communities, in communities that are more vulnerable to certain health risks associated with adverse maternal outcomes,” McGregor said.

“The first solution,” she continued, “is to put laws in place that stop maternity wards from closing as frequently as they are and as disproportionately in vulnerable communities as they are. We need a payment system that increases payment levels for Medicaid. Medicaid should not be paying at rates that are much lower than other payers, which then gives incentives for hospitals to avoid communities with large proportions of Medicaid-insured patients. The federal government ought to encourage states to bring those levels up.”

Listen to The Wheelhouse interview: Why are Connecticut’s roads so dangerous (McGregor at 36:00)