Dr. Baker’s story

Being pregnant down South can be dangerous—and for some, it’s getting worse

Troup County, Georgia — As the first rays of sunlight peek over the rolling hills of LaGrange, Georgia, Dr. L. Joy Baker is already on her way to West Georgia Medical Center. In this charming Southern town a quiet crisis is unfolding. Dr. Baker, an obstetrician-gynecologist with deep local roots, stands on the front lines of a worsening nationwide struggle: the fight for equitable access to maternal healthcare. Each day, as she balances patient care and community advocacy, Dr. Baker embodies the challenges and joys of providing essential services in America's often-overlooked rural landscapes.

“We are the closest hospital for four counties in this area,” Dr. Baker says. “We know that women who have to travel farther for care are at a higher risk for adverse perinatal outcomes.” This risk is not theoretical—it's a daily reality for 2.3 million reproductive-aged women who live in maternity care deserts (areas without any birthing facilities or obstetric clinicians), as revealed in March of Dimes’ 2024 report, Nowhere to Go: Maternity Care Deserts Across the US. Over 3 million additional women live in counties with limited maternity care access.

“There are lots of obstetric emergencies that can occur that literally you have minutes to respond to.” Families who live in maternity care deserts face significant hurdles, such as having to travel 2.6 times longer to reach a birthing hospital than those who live in counties with full access. This puts moms and babies at higher risk for negative outcomes, including preterm birth, maternal morbidity, and stillbirth. Dr. Baker notes that her patients travel anywhere from five minutes to two hours for care. “Any pregnancy, even if it's a low-risk pregnancy, can become high risk in a moment's time,” she says. The urgency of timely care cannot be overstated.

The issue is compounded by health disparities, particularly in Georgia, where the situation is exacerbated for Black and Native American pregnant people. Dr. Baker points out that Black moms face a death rate 2.7 times higher than their White counterparts, a disparity that worsens in rural areas. In LaGrange, Black families make up 52.4% of the population.

Structural and systemic racism, embedded within institutional policies and practices, have long influenced health outcomes and can lead to delays in diagnosis and treatment, dissatisfaction with care, and dismissal of health concerns among Black women. “We have to consider the historical context, and we can see that some of the states that are doing the worst are in the South,” Dr Baker says. “The actual father of modern gynecology experimented on enslaved women, and so when we think about how medicine has grown up with some of this ingrained racism, we have to think about how that affects the care that we're providing today and how biases may still exist.” This is crucial for understanding and tackling the roots of health inequity—one of many solutions necessary for addressing the maternal and infant health crisis.

March of Dimes’ report reveals another startling statistic: over half of US counties don’t even have a hospital providing obstetric care. In 2021 and 2022 alone, more than 100 hospitals (1 in 25) closed their obstetric units nationwide. Dr. Baker explains the ripple effect of these closures: "Many times when a hospital stops offering labor and delivery services, the OB-GYNs and midwives move out that community. And so that kind of creates this vacuum in which there is no obstetric care."

Hospitals continue to shut their doors due to staff shortages, low birth volume, and economic reasons, including low Medicaid reimbursement rates. "That rate is so low that it doesn't make it very attractive to a struggling rural hospital to keep that labor and delivery unit open,” Dr. Baker says. With Medicaid making up more than 40% of births in the US, March of Dimes calls for Medicaid reimbursement rates to be equal to private healthcare plans, especially in rural areas where the impact is felt most acutely.

To address the far-reaching issues of maternity care deserts, Dr. Baker, mirroring solutions outlined in March of Dimes’ report, advocates for policy changes and innovative programs. She supports expanded postpartum care, telehealth, and mobile health to improve maternal outcomes. She also calls for improved support for OB-GYN providers to make practicing in underserved areas more viable.

“There are lots of innovative things that March of Dimes does in terms of mobile health that we’re starting to take note of and get some ideas from,” Dr. Baker adds. As a community-led national program, March of Dimes Mom & Baby Mobile Health Centers^® are uniquely positioned in communities through local partnerships to serve people of color and families in underserved communities regardless of immigration status or ability to pay. “What March of Dimes does for moms and babies is absolutely phenomenal. We were accustomed to a primary focus on preterm birth, but now there’s a broader emphasis on all births, which I believe is crucial for the well-being of moms, families, and babies across this country.”

March of Dimes’ maternity care deserts report and Dr. Baker's insights highlight the urgent need for action. As Dr. Baker puts it, "Women are the centers of families and they're also the centers of communities. So if we don't take good care of our women, then we are really doing a disservice to our entire community." It's time for policymakers, healthcare providers, and communities to come together to address this worsening crisis. The health of moms and babies—and by extension, the health of our society—depends on it.

Dr. Baker shared her story with March of Dimes in September 2023. The maternity care access designation may have changed in her county since then.