By Leah Shepard / Broadcast version by Nadia Ramlagan reporting for the Kent State-Ohio News Connection Collaboration.

In Ohio, 13 of 88 counties are maternity care deserts, affecting approximately 97,000 women, according to data provided by March of Dimes. 

A county is classified as a maternity care desert if there are no hospitals providing obstetric care, no birth centers, no OB-GYN’s and no certified nurse midwives, according to March of Dimes. Bianca Zarders, maternal and infant health manager for the Cleveland Market Branch of March of Dimes, said 4,118 babies were born last year to Ohio mothers who live in maternity care deserts.

“In Ohio and on a national scale, a lot of the research shows that a lot of these women may have to drive 30, 40, 50 minutes to get to their nearest birthing hospital,” Zarders said. “And that is so problematic too, because if they’re struggling to pay for gas, or they have multiple kids who are at day care or in school, finding just the time to actually go to a prenatal appointment or to give birth and having to drive 50 minutes to get somewhere is insane.”

The dearth of maternity care in the state is getting worse, said Natasha Takyi-Micah, public policy and external affairs associate at the nonprofit Center for Community Solutions in Cleveland.

“And a few weeks ago, University Hospitals in Ashland announced that they were closing their maternity department,” Takyi-Micah said. So pretty much, that county does not have any hospitals that offer labor and delivery services unfortunately.”

The closing of the maternity department at Ashland comes eight months after University Hospitals closed their maternity department in Portage County in order to consolidate labor and delivery services at UH Geauga Medical Center in Geauga County. 

In a press release, University Hospitals said that declining birth rates and staffing shortages are both reasons for the closing the maternity department in Portage County. They said in July that the Ashland branch is closing for the same reasons. 

“The reason why a lot of hospitals are closing their labor and delivery departments or maternity wards is because of what happened during the pandemic,” Takyi-Micah said. “It seems the pandemic exacerbated many problems that came to staff shortages in the hospitals, and also there was a decline in births.”

Dr. Maria Phillis, an OB-GYN and member of the American College of Obstetricians and Gynecologists, said maternity care deserts force some patients to travel unusually far for appointments, especially if they need specialized care.

“One of our notable things we have to fill gaps for is higher-level care,” she said. “So for example, at one of the institutions that I’ve worked at, we had a patient with significantly poorly controlled diabetes who was coming essentially more than an hour and a half for high-risk appointments and wasn’t able to routinely travel that distance.”

Phillis said that many of these patients travel from very rural areas where obstetric care is unavailable.

Zarders, who works in research, policy and legislation for the March of Dimes as well as community outreach, said the lack of maternity care coupled with chronic health conditions, like diabetes, hypertension and smoking, often lead to poor childbirth outcomes and preterm births.

She said other widespread issues affect whole communities. 

“Another overarching theme is community level issues,” Zarders said. “Like socioeconomic status or environmental factors. Those also fuel the disparity when it comes to receiving adequate prenatal care, especially in communities of color.”

Zarders said that at some hospitals, women are turned away entirely because of lack of care, and that this is something that happens on a national scale.

“I recently heard a story where a woman ended up in an emergency room because she was in labor,” Zanders said. “And the nearest hospital just had an emergency room. And she was actually denied care because they didn’t have an OB person present. And so they actually asked her to go to another hospital.”

Takyi-Micah said the Center for Community Solutions is working to influence policy at the state level to alleviate this problem. 

“We just wrapped up the state budget,” she said. “We have been advocating for doulas to be reimbursed through Medicaid so more people have access to them, since they are one of the solutions to reduce the infant and maternal mortality crisis. So, that language is now included in the budget.”


This collaboration is produced in association with Media in the Public Interest and funded in part by the George Gund Foundation.


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More than 20% of nursing positions in the Commonwealth remain vacant, according to the Kentucky Hospital Association - and combined with workforce shortages in other medical professions, the state is facing a massive health-care workforce crisis that could have crippling effects.

Ben Chandler, CEO of the Foundation for a Healthy Kentucky, said the shortages are both straining overworked existing providers and making it more difficult for residents to access quality care.

"We're seeing shortages, really across the board. We're certainly seeing shortages in nurses," said Chandler. "We're also seeing shortages for primary-care physicians. These are important entry points into the health-care system."

The state needs at least 16,000 additional nurses to meet demand by 2024, according to data from the Kentucky Healthcare Collaborative.

State Sen. Stephen Meredith - R-Leitchfield - will be the keynote speaker at the Foundation for a Healthy Kentucky's Bost Forum next week in Lexington, highlighting the challenges facing the medical community and proposing potential solutions.

He said the health-care system is the backbone of rural economies.

"If the health system in rural Kentucky collapses, then it's just a chain-reaction event," said Meredith. "It's going to cause a crisis throughout the state. It's something we need to take seriously, and it needs solutions today."

According to the Bureau of Labor Statistics, nationwide around 1.8 million job openings are projected yearly between now and 2032, driven by increased demand and the need to replace workers who have permanently left health-care occupations.




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In rural Arkansas, access to healthcare can be a distant dream - literally - as almost 60 counties in the state do not have enough providers to serve their populations. A new initiative with the Health Resources and Services Administration is working to improve access in these areas, through telehealth.

Heather Dimeris, director, Office for the Advancement of Telehealth at the Health Resources and Services Administration, said delivering care remotely online fills a crucial gap. Arkansans can visit telehealth.hhs.gov to explore their options, including behavioral and mental-health services.

"You can look at anxiety or depression screening through telehealth," she said. "You can also receive treatment for your anxiety or depression and other mental health needs, through one-on-one therapy as well as group therapy. And telehealth has also been extremely helpful in treating patients with substance-use disorders."

Dimeris noted 40% of all behavioral healthcare is now done virtually, including therapy, addiction counseling, and mental-health screening. She adds HRSA also provides telehealth services for treatment of chronic diseases, like diabetes, and information for healthcare providers.

However, the growth of telehealth spotlights another challenge for rural Arkansas - the lack of reliable, affordable internet service. Dimeris added some people can use their cell phones for telehealth services. Or they can apply for discounted internet access through two programs offered by the Federal Communications Commission.

"The Affordable Connectivity Program, as well as the Lifeline Program," she continued. "Both of these programs have eligibility requirements. But if you meet them, you really are able to access either free or reduced cost for broadband services and cell phone services."

Lower-income households can get up to $30 a month off their internet service bill, or $75 a month if they live on tribal lands, according to the FCC.

California's medical aid-in-dying law is back in court. Three patients with disabilities and two doctors are asking to intervene in a lawsuit challenging the law - and they want the judge to dismiss the suit.

In April, a coalition of disability rights groups and people with disabilities sued to stop the End of Life Option Act, claiming it is discriminatory and "coerces" people with disabilities into using medical aid in dying.

Jess Pezley is the senior staff attorney with Compassion & Choices, which supports the bill.

"It's not discriminatory to offer an additional end-of-life option," said Pezley. "And there's a lot of safeguards built in within the act to make sure that this law is not being used by people who do not want it. The only people who qualify for it are terminally ill with a prognosis of six months to live, and who have the capacity to make the decision."

California is one of ten states - plus Washington, D.C. - that allow doctors to prescribe medication that would allow mentally capable, terminally ill adults to peacefully end their suffering if they choose to take it.

Peter Sussman is a retired journalist and author from the Bay Area who said he lives with constant and disabling pain after a series of spinal surgeries. He said he supports medical aid in dying, and has joined the motion to intervene in the lawsuit.

"When my time comes and I am certified by doctors to be dying within six months, I do not want to die suffering needlessly," said Sussman. "The government shouldn't be able to tell me the manner of my own death."

The State of California, the defendant in the lawsuit, has also filed a motion to dismiss.

Earlier this year, the same judge dismissed a different challenge to the suit brought by the Christian Medical and Dental Association - after it reached a settlement with the state that said doctors who have a religious objection don't have to record a patient's request for medical aid in dying on their chart.