KU School of Nursing releases report on access to maternity care in Kansas

The growing maternal-care desert in Kansas is causing more women in the state to drive long distances for care and 59% do not have local access to inpatient maternity services, according to a report released today by the University of Kansas School of Nursing.

The report, Access to Maternity Care in Kansas, was produced by KU School of Nursing in collaboration with the Kansas Center for Rural Health, and with funding from the United Methodist Health Ministry Fund. The report describes and defines issues surrounding the availability of maternity care in Kansas.

Over the last 10 years, many rural hospitals across the country have closed or have stopped offering maternity care services altogether. This includes in Kansas, which is second only to Texas in terms of the number of counties considered rural. Rural hospitals are at an increased risk of closure due to declining occupancy rates, high fixed costs and market pressures.

“Kansas legislators, health care systems, foundations, professional organizations and educational institutions are all working hard to address the concerns of access to care and the health care workforce,” said Karen Weis, Ph.D., FAAN, dean of KU School of Nursing-Salina and lead author of the report. “Sound data is needed to support these efforts. The Access to Maternal Care in Kansas report is a first step in gathering that data in one central source.”

Access to quality perinatal care, which includes care during pregnancy and after the birth, is critical to the health of newborn babies and their mothers. Closures of hospitals and cessation of maternity services are correlated with more babies being born early, more infants admitted to neonatal intensive care units and more women dying during pregnancy or in childbirth.

The report outlines, by county and ZIP code when possible, the numbers of women of reproductive age in the area, the facilities offering prenatal care or inpatient maternity care; the availability of referral and high-risk services; and the providers accepting patients and offering prenatal or full perinatal services, nursing, anesthesia, behavioral health, lactation, and doula support services. It also provides the distances to facilities with delivery capabilities.

Key findings in the report, which is based on data from 2022-2024, include:

• An increasing number of Kansans travel up to 60 miles for low-risk prenatal and postpartum and labor and delivery care, particularly in the central and southwest parts of the state.
• Fifty-nine percent of Kansans do not have local access to inpatient maternity care.
• The availability of services for women with high-risk pregnancies is extremely limited. Close to 30% of ZIP codes in Kansas are more than 100 miles away from tertiary, high-risk services.
• Forty-two counties in Kansas are without any documented anesthesia providers, and most of those are on the western side of the state.

The report also found that the counties with the highest birth rates are the ones losing access to maternity care services. And rural counties had higher birth rates than urban ones: 67 versus 61 live births per 1,000 women of reproductive age.

"To me, the biggest surprise in the report are the two counties in western Kansas with the highest birth rates,” said Weis. Neither of these counties, Wallace and Grant, have a health care system offering maternity care. The distance to inpatient maternity care for those residing in each county is approximately 50 miles and 24 miles, respectively.

The report also provides information clarifying the unrecognized costs of providing maternal health care, which requires the presence of multidisciplinary teams of providers and nurses 24 hours a day, 7 days a week, 365 days a year. The vast majority of rural hospitals are reimbursed through a Medicare-reimbursement model, which does not cover the high cost of providing maternity care.

"These data paint a stark picture of the current landscape of access to maternal health. The data also emphasize the critical importance of addressing this challenge before it gets worse, as well as recognizing that the location of services is one piece of the puzzle,” said David Jordan, MPA, president and chief executive officer of United Methodist Health Ministry Fund, which is based in Hutchinson, Kansas. “We need to figure out solutions to complete the puzzle in order to provide women, children and families across the state with better access to the services they need to thrive.”