Republicans’ efforts to repeal and replace the Affordable Care Act will likely mean very bad things for women’s health. We stand to lose insurance coverage of contraception and maternal and newborn care. But the majority-Republican House of Representatives gave us a teeny, tiny reason for hope on Tuesday night by passing a bill called the Improving Access to Maternity Care Act. It doesn’t mean that we can count on women’s health being a priority in whatever plan replaces the Affordable Care Act, but it does confirm that there are Republicans who understand that women have unique health needs that cannot simply be ignored. At this moment in the time, with the bar for caring about women set so low by Trump, his proposed cabinet, and the Republican leadership, I’ll take this as good news.
The Improving Access to Maternity Care Act is a bipartisan bill that would require the Health Resources and Services Administration (HRSA) to identify regional shortages of maternity health professionals around the country. HRSA currently identifies shortages in three other areas: primary care, mental health care, and dental care. The bill would allow the National Health Service Corps, a unit of the Department of Health and Human Services that was created to address medical provider shortages in underserved areas, to place more OB-GYNs and certified nurse midwives in those areas. A previous version of the bill was first introduced in March 2015 and passed the House last November, but never made it to the Senate floor.
PredictGov gives the new bill a 21 percent chance of being enacted, which is a real shame. There’s currently a serious shortage of maternal care providers in the United States that will continue to worsen if measures aren’t taken to address it. According to the American College of Obstetricians and Gynecologists and the American Midwifery Certification Board, in 2013 there were only four OB-GYNs, certified nurse midwives, or certified midwives for every 10,000 women over the age of 15 in the United States. Unsurprisingly, the effects of this shortage are felt most keenly by those living in sparsely populated states and rural areas. A study from the American College of Nurse-Midwives found that 46 percent of U.S. counties have no OB-GYNs and 56 percent have no nurse-midwives.
Certified nurse midwives, who undergo years of extensive training and are therefore more reputable than other classifications of midwives, hope that passing the law would put pressure on states to reduce restrictions on them. Currently, six states require certified nurse midwives to work under physician supervision, which limits their ability to run practices and treat patients in underserved areas. There have been recent legislative attempts in states like North Carolina and California to ease these restrictions and allow certified nurse midwives to operate on their own, which advocates argue would lead to better health outcomes for mothers and children. California state data shows that counties with few or no OB-GYNs had among the highest preterm birth rates in recent years.
Much of the work currently set out for those of us seeking to protect women’s health involves warding off the destruction of effective and just policies and protections. But with the Improving Access to Maternity Care Act we have the sadly rare opportunity to get behind a policy that represents progress and has bipartisan support. All those looking for ways to avoid the Trump-induced apocalypse should add supporting this bill to their daily action lists.