Making kids’ start even rockier: Hospitals reduce obstetric care
It’s a good bet that if asked, most folks of a certain age easily can name the hospital in which they were born. That’s partly because these important health care institutions once sought to build lifelong relationships with their patients, starting with moms and babies.
That bond, however, may be breaking down fast, as the suit-wearing MBAs who run big hospitals seek to maximize profits, especially by jettisoning less lucrative services.
They’re not only throwing out pediatric treatment but also the proverbial bath water — obstetrics and maternity services, the news and information site Axios reported:
“Obstetric unit closures predate the pandemic but are drawing more concern with pregnancy-related deaths on the rise and an increased need for obstetrics care as more states restrict abortion …Hospital administrators say the closures are driven by low Medicaid reimbursement rates, staffing shortages and, in some cases, declining birth rates in areas the hospitals serve. Medicaid pays for about 40% of U.S. births … Rural hospitals saw the biggest drop off of such services from 2014 to 2018, and Covid-19 actually slowed the pace of cutbacks because of a surge of pandemic relief funding. That lifeline is all used up at this point, however, forcing some facilities to slash costs and close units.
“From 2004 to 2014, 9% of rural counties lost their obstetrics services, per a Health Affairs analysis, with an additional 45% of rural counties having no obstetrics services during the study period. Rural patients also tend to be poorer, which means those hospitals rely more on Medicaid payments that administrators say don’t cover the cost of birthing services and care. The Government Accountability Office cited the matter in a 2022 report as a top concern for stakeholders.”
These service cutbacks will only worsen health care inequities, Axios reported:
“Not all hospitals are cutting their delivery units. Some offer luxury birthing suites with soaking tubs, large beds and other amenities that usually come with a high price tag and cater to patients with private coverage or those willing to pay out-of-pocket.”
For pregnant women in this country — who already experience poor maternal care, especially in comparison with their peers elsewhere on the planet — reductions in services will only increase their health risks:
“Providers and advocacy groups have sounded alarms about ‘maternal care deserts’ in states with strict abortion restrictions, a problem that’s manifested itself in longer drive times to facilities that still have OB-GYN services, less access to pre- and post-natal care and poorer birth outcomes in many regions. ‘You can’t have it all the ways: you can’t make abortion illegal, not have access to maternity care, and also by the way, restrict and make it harder for people to access contraception,’ Anne Banfield, an obstetrician and American College of Obstetrics and Gynecology member, told Axios. ‘But we’re going to do all three of those things and expect to have a good outcome? Logic has no place here.’”
A notable and worrying trend: a shrinking next generation
Self-interest should be a giant motivator for this country to make big efforts to improve the health care of its young.
They’re the future and, alas, membership in this next generation is shrinking.
As the nonpartisan, independent Brookings Institution reported of this crucial U.S. demographic trends:
“Previous analyses of Census Bureau estimates make plain that the nation’s population growth has ground down to a historic low: only 0.1% growth between July 2020 and July 2021. During this prime year of the Covid-19 pandemic, the number of deaths rose sharply, births declined, and immigration reached its lowest levels in decades. At the same time, population movement within the U.S. led to sharp declines in many of its largest metro areas—particularly in these areas’ biggest cities. Now, newly released Census Bureau estimates allow us to examine these shifts via specific race-ethnic and age groups …
“The examination of age shifts shows a loss of young people under age 18 and those in their prime working ages (18 through 59). Moreover, when looking at age and race, it becomes clear that nonwhite Americans, especially Latino or Hispanic Americans, comprise larger shares of the population at all ages.”
The nonpartisan, independent Pew Charitable Trusts offered another research-based analysis of why the nation has fewer young folks, reporting:
“Changing societal norms and other factors have reshaped recent generations of American families. Following the baby boom from 1946 to 1964, birth rates plummeted through the early 1970s, then fluctuated little in succeeding decades. The Great Recession marked another turning point; fertility had slowly climbed in the years leading up to 2008 before tumbling. It has mostly continued to fall since then, with the latest available data covering 2020—and reflecting children conceived prior to the pandemic—showing 43 states recorded their lowest general fertility rate in at least three decades.”
While states may see fiscal benefits in not having to fund programs to educate and care for kids, the long-term consequences of fewer young folks will be plain, direct, and potentially painful, Pew found:
“The historic decline in fertility will touch nearly every area of state budgets in the coming years. Some fiscal effects have already emerged, while others will be relatively minor or won’t be felt for decades. The implications for individual states vary: Those with shrinking workforces that rely more than other states on taxes sensitive to population declines—such as income and sales taxes—are especially vulnerable to budget pressures. Other demographic shifts such as migration will also affect many sources of revenue and spending.”
While experts debate exactly why fewer adults are choosing to have a dwindling number of kids, a recent USA Today Op-Ed offered a different take from scholars in human behavior and public opinion. They said it would be too simple just to say that grownups have grown grim about the future, notably with fears about war, climate change, and other calamitous scenarios looming.
Instead, Clay Routledge and Will Johnson opined, based on their studies, that people all over the planet now put a premium on lives of independence. They want to pursue interests and paths that they hope bring meaning to their existence — and they don’t see as much now how children fit into these aspirations.
That could make it tougher for policy makers and opinion shapers to sway grownups of child-bearing age to start and raise families that societies need to thrive.
Here are the Op-Ed conclusions offered by Routledge, vice president of research and director of the Human Flourishing Lab at the Archbridge Institute, and Johnson, CEO of The Harris Poll, a global public opinion, market research and strategy firm:
“For much of our history, most humans lived far more perilous lives than we live today. Our challenge is less about our material conditions and more about our mindset. If we want a world with more children, we are going to have to convince people that having and raising kids is a critical ingredient of, not a barrier to, the good life.”