This OB-GYN is concerned about Arizona’s rural maternity care deserts

NEED TO KNOW:

• 6 Arizona counties have fewer than 1 OB-GYN per 10,000 women.

• Of those, Greenlee County had no obstetric care providers in the entire county. 

• Misha Pangasa, an OB-GYN at Planned Parenthood AZ, said it isn’t as simple as other OB-GYNs saying they want to work in maternity care deserts.

• Cuts to programs like Medicaid will exacerbate already existing healthcare issues in the US.

When a pregnant woman in Greenlee County faces complications late in a pregnancy, the nearest birthing hospital is, on average, over 47 miles away.

Hospitals in rural areas might not always be fully equipped to deal with complications in pregnancies, according to Dr. Misha Pangasa, an OB-GYN at Planned Parenthood AZ.

Pangasa, who practiced medicine in multiple states before returning home to Arizona to offer care in Phoenix, said she regularly hears from health care providers in other parts of the state who are unprepared for pregnancy emergencies.

“I’ve gotten calls from rural hospitals who are concerned because sometimes they have no idea what to do when a pregnant patient with a complication is rolling into their emergency room,” Pangasa said.

It’s not surprising that fewer OB-GYNs practice in rural areas. After all, fewer residents (and therefore fewer potential patients) means a need for fewer doctors. But that alone doesn’t adequately explain why the ratio of OB-GYNs is significantly lower in rural areas compared to more populated areas.

Arizona has 2.03 OB-GYNs per 10,000 women, according to a University of Arizona report from 2020. That’s a little behind the national average 15 years ago of 2.65 per 10,000 women.

A 2023 report from March of Dimes showed that Greenlee County had zero hospitals and birthing centers that offered obstetric care, while La Paz, Graham, and Cochise counties only had one.

A lack of OB-GYNs in rural areas doesn’t just mean that people have to travel far distances when they’re about to give birth. There are routine check-ups, of course, and high-risk patients may also need to make that trek several times a month just to ensure their pregnancy is progressing safely.

“It’s not just one time that they have to drive a long distance if people are in labor,” Pangasa said. “The reality is that there is not the capability to handle a lot of the more complicated issues that arise in pregnancy in a lot of these rural areas.”

According to the Rural Health Information Hub, women in rural areas have a higher probability of experiencing things like sepsis, pulmonary edema, and acute renal failure, as well as mortality.

No easy solution

Addressing maternity care deserts is not as simple as just finding and sending more obstetricians and gynecologists to counties who need them. There’s also the issue of infrastructure, and infrastructure costs money.

“In reality when we’re talking about obstetric deserts or maternity care deserts, you’re also talking about having a hospital that can…handle issues related to people who are pregnant, and have the ability to manage some of the complications or emergencies related to being pregnant,” Pangasa said.

So even if a rural hospital has the space, staff, and equipment to handle something relatively straightforward — like a routine vaginal delivery — that doesn’t mean it’s prepared for everything that can come with pregnancy and delivery. Complications can arise quickly, and not all facilities are equipped to manage emergencies like preeclampsia, preterm labor, or postpartum hemorrhage.

READ MORE: Republicans’ Medicaid cuts pit working Arizonans against the ultra wealthy

While Pangasa admitted she is not well-versed on what it takes financially to keep a hospital open, she noted that the business of managing pregnancies and delivering babies isn’t typically a big moneymaker for hospitals.

In fact, according to one study, obstetrics and delivery services are one of the biggest money losers for hospitals.

“It’s sort of a sunk cost for [hospitals],” she said. “So if there are cuts that need to be made to hospital services, [obstetrics] are often the first to go.”

The study further confirms that, noting rural hospitals are closing obstetric departments with more frequency in order to keep hospitals financially viable.