Womens Enews reports that maternity wards and obstetric units are closing across the country. Depending on where you live, and whether or not you have health insurance, you could be far away from the medical care you need. The number of babies born in the US has remained stable, at just over 4 million a year. But 1.3 million women joined the number of uninsured between 2008 and 2009. Now 22% of all women of child-bearing age are uninsured. Medicaid covers 15% of them. But the Medicaid reimbursement rate is well below the actual cost. Rather than provide services for nothing or below cost, hospitals simply stop offering maternity care. This pushes more and more uninsured pregnant women into a shrinking number of obstetric wards, where the waiting gets longer and longer and staff and supplies are taxed beyond the breaking point.

Pennsylvania is a case in point. In the past 13 years, over 39 hospitals have shuttered their maternity wards. Now, uninsured women must typically wait 11 1/2 weeks for their first pre-natal visit, the very end of the first trimester. In Alabama, nearly half of all obstetric units have closed in the past 30 years, from 58 in 1980 to a current 32. Comparable situations can be found from coast to coast and north to south, in both rural and urban areas.

In addition to clear limitations on women's access to pre-natal and maternity care, another story surfaced recently which shows a more nuanced way in which women's access to health care is restricted. Where I live in Montgomery County, Maryland, regulators accepted multiple proposals to build a single new hospital. Two organizations were in contention, one a Catholic hospital, and one called Adventist Healthcare. The Catholic hospital was granted authorization to expand. But the new hospital, like all Catholic hospitals, will not provide certain services to women treated there. No hormonal contraception will be offered. No pregnancy termination procedures will be performed, even in the event of rape, incest, or if the life of the mother is in danger. No tubal ligations will be available, and the only remedy for an ectopic pregnancy will be one that removes the involved fallopian tube, rather than an alternative procedure which preserves fertility, leaving the fallopian tube intact. In explaining their decision, state regulators cited the fact that there are no state standards which would require a hospital to provide these services. Thus, in order to access any health care at all, uninsured and under-insured women seeking care at this new facility can receive some treatment, but not necessarily what they want, or what the doctor prescribes, or what they need. Some treatment is simply off the table. It would have been available but for the regulators' decision.

Of course, many women can buy their way out of this problem. With the money, the means, and transportation, you can select the physician, hospital, and treatment of your choice. But not evey woman, not all women, have that ability. Women are far more economically vulnerable than men, and rely more on public programs, including Medicaid. So, this is healthcare rationing, with money as the determining factor. It's also gender discrimination. Men don't need tubal ligation, and they can't develop an ectopic pregnancy. Only women are affected by the elimination of obstetric care, or limitations on the kind of reproductive care available. Furthermore, the individuals charged with authority in Catholic hospitals to enforce the directives for permissible care, or settle disputes about them,are the local bishops, uniformly male, unmarried, and unlikely to be parents. Economic pressures are forcing mergers between hospital systems, and Catholic hospitals find an increasing number of medical facilties under their authority. The number of women seeking medical care in a religious hospital is bound to go up. At the same time, all indications point towards an increasingly conservative theology, from the Vatican on down. So where do we end up? More women, less access, restricted options, resulting from state regulatory power. A violation of the separation of church and state? For women, at any rate, perhaps more of an unholy alliance.

Here are the articles that prompted this post, one from Women's Enews and from the Washington Post here and here.

If you really want to wonk out on the issue, the National Women's Law Center has just released a report on this topic. Do let me know how you feel about it all.

'til next time,

Your (Wo)Man in Washington