Digital health can improve health outcomes in maternity care deserts

Maternity care deserts have become an alarming reality for millions of Americans, significantly impacting maternal and infant health outcomes. A maternity care desert is defined as a county without a single hospital or birth center offering obstetric care and without any obstetric providers. According to a 2024 March of Dimes report, over 35% of U.S. counties are classified as maternity care deserts, affecting more than 2.3 million women of reproductive age. This lack of access to essential maternal healthcare services has created a crisis in many parts of the country, particularly in rural areas where 61% of maternity care deserts are located. 

The State of Maternity Care Deserts 

The consequences of living in a maternity care desert are significant. Women residing in these areas face a higher risk of pregnancy-related complications and death. A 2022 study published in Women’s Health Issues found that the risk of death during pregnancy and up to one year postpartum in Louisiana due to any cause was 1.91 times higher for women in maternity care deserts compared to those in areas with greater access. Additionally, babies born to individuals living in maternity care deserts are more likely to receive inadequate prenatal care with a reported 15.8% not receiving adequate care from 2020 to 2022. Prenatal care has been shown to reduce the risk of pregnancy-related complications. Finally, preterm birth rates are higher in maternity care deserts than full access counties across all races and ethnicities. 

How Digital Health Closes Geographic Care Gaps

Digital health innovations provide an opportunity to bridge the gap in maternity care access. Telehealth and remote patient monitoring (RPM) technologies show promise in managing high-risk pregnancies and improving maternal health outcomes. Companies like Babyscripts offer both patient education and remote pregnancy monitoring solutions, including blood pressure cuffs and gestational weight gain tracking tools with wifi-enabled devices. Bloomlife supports high risk patients who require additional clinical monitoring by equipping them with cellular-enabled fetal monitors that feed data back to the patient’s care team. Marani augments traditional maternity care with a patient-facing app, provider portal, cellular connected devices, and a 24/7 remote care team staffed by maternal fetal medicine doctors licensed to treat in all 50 states. Additionally, in October 2024, the NIH announced 8 winners of the Rapid Acceleration of Diagnostics Technology (RADx® Tech) for Maternal Health Challenge, an $8 million prize competition to encourage development of postpartum maternal health diagnostics for use in regions that have limited access to maternity care. The devices were evaluated by researchers and pregnant people through Emory University, and demonstrate the latest in health technology innovation. 

Remote Patient Monitoring for Maternity Care is Supported by Experts 

During the Covid-19 crisis, the American College of Obstetrics and Gynecology released an advocacy brief urging guaranteed insurance coverage of telehealth visits regardless of geographic location and for both privately-insured and Medicaid-covered patients. (Medicaid finances 41% of births in the United States.) The brief also states, “Evidence indicates that remote patient monitoring interventions result in fewer high-risk obstetric monitoring visits while maintaining maternal and fetal outcomes.” While this document came out during a global pandemic, it stands to reason that maternity care deserts would benefit from the same logic. 

What Care Teams Need to Succeed with Maternity RPM Programs 

New technology cannot be wedged into traditional care delivery thoughtlessly, nor can it stand alone when it comes to maternity care. Ideally, upon a person’s first prenatal visit which confirms pregnancy, providers would assess their patient’s geographic and medical risk to determine if RPM is a good option. Patients need to be educated on how to use the technology in conjunction with their in-person care as well as any associated costs not covered by their insurance plans. 

Prior to adopting RMP programs, healthcare workers in clinics and hospitals need to establish clear guidelines on patient eligibility and consent requirements, standards for data security and patient privacy protection, training on RPM technology and best practices for remote care management, and plans for responsible parties to review RPM data and triage algorithms in the case of abnormal readings. No one wants software and hardware that is meant to help to become a legal liability. 

The future of maternal healthcare in underserved areas looks promising with the advent of digital health technologies. These innovations have the potential to significantly improve health outcomes for women in maternity care deserts by providing access to specialized care, regular monitoring, timely interventions, and peace of mind. However, technology alone is not enough. There is an urgent need for policy improvements to address this crisis. Policymakers should focus on increasing funding for maternal healthcare hospitals in underserved areas, setting reasonable reimbursements rates for telehealth services at the federal level, and funding internet and cellular infrastructure to ensure healthcare data generated by patients reaches their provider reliably. By combining technological advancements, with open-minded care providers as well as supportive policies, we can work towards eliminating maternity care deserts and ensuring that every woman has access to the care she needs during pregnancy and childbirth.

Katie D. McMillan, MPH is the CEO of Well Made Health, LLC, a business strategy consulting firm for health technology companies. She is also a curious researcher and writer focusing on digital health evidence, healthcare innovation, and women’s health. Katie can be reached at [email protected] or LinkedIn.