As maternity wards close, Arizona mothers pay price

Eileen Appelbaum

Submitted photo/InsideSources

Labor and delivery departments are a money-losing proposition for hospitals. They operate 24/7 and need to have obstetricians, obstetrical nurses and anesthesiologists available at all times. Insurance companies pay for the delivery of a baby, not for the cost of maintaining an obstetrical department. Meanwhile, the number of births is going down, making it difficult for many hospitals to maintain a high enough volume of births to cover the costs of maintaining the service.”

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OPINION — Giving birth can be deadly. In 2024 in the United States, 17.9 women per 100,000 live births died during pregnancy or within 42 days after childbirth.

That is double or triple the number in other high-income countries, and much higher than in English-speaking peer countries Australia (3.5), Britain (5.5) and Canada (8.4). 

More shamefully, the number of maternal deaths among Black women in America is a shockingly high 44.8 per 100,000 live births. 

One reason patients aren’t getting the maternal care they deserve in the United States is that healthcare is increasingly being treated as a financial asset rather than a public service. 

This failure of the healthcare system to provide adequate care for those giving birth points to the need for investment in maternity-care infrastructure: physical facilities and training of obstetrical clinicians. Unfortunately, this is not happening. Changing the way infrastructure is funded could save lives. 

Recently, the March of Dimes released its biennial report on maternity deserts in the United States. It found that at least 96 labor and delivery units across 35 states closed from 2024 to early 2026. More than one-third (34.6%) of U.S. counties are what the report terms maternity-care deserts, meaning they have no obstetric clinicians, no hospitals with OB-GYN facilities and no freestanding birthing centers staffed by trained midwives. More than half lack a hospital with labor and delivery services. 

Maternity-care deserts are most often found in rural areas, low-income communities and those with higher uninsured rates among women. Nearly 70% (69.6) are found in rural counties. In the South and Midwest, 38.7% of counties are maternity deserts compared with 26.4% in the West and 5.1% in the Northeast. 

A major reason for this sorry state of affairs lies in how the United States finances investment in health infrastructure. Hospitals, including nonprofits, must borrow in financial markets to modernize existing facilities or build new ones. To do this, they must demonstrate that they are creditworthy and can repay lenders when debts come due, that their revenues exceed their expenses by a healthy margin. 

However, labor and delivery departments are a money-losing proposition for hospitals. They operate 24/7 and need to have obstetricians, obstetrical nurses and anesthesiologists available at all times. Insurance companies pay for the delivery of a baby, not for the cost of maintaining an obstetrical department. Meanwhile, the number of births is going down, making it difficult for many hospitals to maintain a high enough volume of births to cover the costs of maintaining the service.  

Payments from Medicaid, which covers more than two-fifths (40.4%) of births, often do not cover the full costs of delivery.  

These pressures are especially serious for rural hospitals, which see relatively few births. They need to shut down these services to maintain profitability and to borrow funds they need to modernize their facilities and keep the doors open. 

So, what is the alternative? Public financing of the infrastructure and technology needs of nonprofit hospitals, as is common in most other wealthy countries. This would be transformative. And the United States has done it before.  

At the end of World War II, President Harry Truman realized that 45% of U.S. counties, especially in the South, did not have even one hospital and could not meet the needs of returning troops. In 1946, at his urging, Congress passed the Hospital Survey and Construction Act — known as the Hill-Burton Act — to provide loans and grants for construction of nonprofit hospitals and health facilities. From 1946 to 1997, when it ended, the Hill-Burton Act had partly financed about 6,800 hospitals and health facilities in 4,000 communities. 

Nonprofit hospitals cannot put patients’ needs first when they must consider the effects of their actions on their creditworthiness. Public financing of nonprofit healthcare infrastructure will free them from the need to demonstrate they are profitable. It will enable them to fulfill their mission of providing vital health services to the communities they serve and providing the best possible care for every patient they see. 

Eileen Appelbaum is an economist and co-director of the Center for Economic and Policy Research and co-author of the book “Healthcare in the Age of Financial Capital: Public Funds for Private Gain.” She wrote this for InsideSources.com. Please submit comments at yourvalley.net/letters or email them to AzOpinions@iniusa.org. We are committed to publishing a wide variety of reader opinions, as long as they meet our Civility Guidelines.