Black women in rural areas are facing the brunt of declining medical services, including access to obstetric care, as new policies threaten clinic and hospital closures.

“The risks facing women in rural communities is due to hardship in receiving routine screenings and also access for treatment if conditions or diseases arise. Also, in rural areas there are few specialists,” said Dr. Sonya Buchanan, a preventative medicine physician and Meharry Medical College graduate.

“Most specialists practice in larger cities with larger populations. Commuting to and from for treatment of chronic illnesses or cancer may not be possible for a number of reasons including financial, logistics—or missing time from work.”

In response to recent federal policy changes impacting healthcare funding, Georgia Rep. Nikema Williams (D) introduced the Maternal Health Equity Under Medicaid Act to raise federal matching rates to 90% for Medicaid expenditures on maternal healthcare.

Nearly one in five rural adults and 40% of rural children rely on Medicaid or the Children’s Health Insurance Program. Alongside cost concerns, rural Americans also face geographic barriers that threaten access to care.

Most rural residents live an average of 10.5 miles from the nearest hospital, compared to 4.4 miles for those in urban areas, according to the National Rural Health Association.

“Medicaid is the largest payer of maternity care in this country and must be part of the solution to the maternal health crisis. Too many people are still falling through the cracks in our healthcare system, especially Black mothers who continue to face a worsening maternal health crisis,” Williams said in a statement, noting that 42% of births are financed by Medicaid.

Women who enroll in Medicaid in their third trimester have a 4.7 times higher likelihood of experiencing maternal mortality and a 1.5 times higher risk for infant mortality, according to her office.

“Raising the federal match for maternal care will give states the resources they need to expand care and save lives,” Williams added.

As of 2022, more than two-thirds of rural hospitals in eight states were without obstetric services, according to a Health Affairs study. From 2010 to 2022, 12 states reported the loss of 25% or more obstetric services in rural hospitals.

“The mass closures of obstetric wings in rural hospitals have been a major issue for years now,” said Rep. Alma Adams (D-N.C.). “Labor and delivery units are often the first to get cut when hospital budgets get low.”

The United States remains the only developed country with a rising maternal mortality rate, according to UNICEF, with deaths disproportionately affecting women of color.

Black women are three to four times more likely to die from pregnancy-related complications and twice as likely to lose an infant to premature death, with those in rural communities facing the greatest risks.

All 50 states have access to the federal Rural Health Transformation Fund, which provides more than $100,000 to strengthen and modernize healthcare systems in rural communities.

“While it won’t fully alleviate the burden of these Medicaid challenges, our state will be using some of these dollars to keep rural hospitals in business and expand maternity care access, focusing on non-medical barriers to care as well,” Adams said.

Doulas has also stepped in to help bridge the gap by providing support services, including travel assistance and in-home care.

Historically, Doulas played a critical role in assisting births, particularly in underserved communities. As childbirth shifted into hospital settings, that non-clinical support declined, leaving gaps in care for many expectant mothers.

Research shows that Doulas can improve outcomes while reducing unnecessary medical procedures and healthcare costs. A recent study of Medicaid beneficiaries found that women who received a Doula’s support had lower rates of cesarean and preterm births.

“A birth Doula holds space so birth can unfold with dignity,” said Jacque Souza, a self-employed Doula. “She does not replace medical care but helps mothers make the best decisions when bringing a baby into the world.”

Doulas also provide critical postpartum care.

“A postpartum Doula helps families navigate the unique and delicate time after birth—those days when nights are long and the days feel endless,” Souza said. “She guides and supports new mothers during this profound transition.”