Maternity Care Deserts On South And West Sides See Higher Infant, Maternal Death Rates

AUBURN GRESHAM — A new American Medical Association report studying the impact of OB-GYN clinic closures on maternal and infant health on the city’s South and West sides illustrates glaring disparities in care.

Written in collaboration with Sinai Urban Health Institute, the report — titled “From Facilities to Outcomes: A Neighborhood-Level Examination of Maternal and Infant Care Access in Chicago” — examines maternity care deserts and measures maternal health care access within Chicago ZIP codes using three categories: low, medium and full access.

The study found the range of full maternal care is distributed unequally across the city, with the South and West sides containing the most low-access ZIP codes. Downtown and the North Side had the most full-access ZIP codes.

Three conveniently located clinics on the South and West sides have closed in the past six years, and the dearth of specialists in certain ZIP codes requires expectant parents to seek care outside of their communities.

Nationally, more than 2 million people of childbearing ages, 15 to 44, live in “maternity care deserts,” according to a 2022 March of Dimes report.

Pregnant people in the United States are more likely to die from pregnancy and childbirth complications compared to individuals in other developed countries. But there is an “even deeper divide” between white pregnant people and their Black and Indigenous equivalents, according to the study. 

‘Systemic Injustices Prohibit Access To Resources’

Between 1999 and 2019, Black people had the highest median maternal mortality rate in the United States, while Indigenous people had the largest increase in the median state maternal mortality rate. 

But the disparity between Black and white maternal mortality rates in Chicago is even higher than the national estimate, according to the study. 

Nationally, the maternal death rate for Black mothers was 49.5 deaths per 100,000 births, compared to 19 deaths per 100,000 births for white women, according to a 2024 study from the Centers for Disease Control and Prevention’s National Center for Health Statistics. 

A recent study from the city’s Department of Public Health found Black Chicagoans were nearly six times more likely than white women to die during pregnancy or the year after birth.  

Birth mortality inequities are not because of biological differences but come from systemic injustices that prohibit access to resources, according to the study.  

Pregnant people require pre- and post-natal care, but when that care is not available, “the impact to maternal and fetal outcomes is often more influenced by factors beyond the control of the pregnant person,” according to the study.

Additional findings:

• The number of obstetric and gynecological beds in Cook County ranges from 12 to 134, and neonatal intensive care unit bed capacity in Cook County ranged from eight to 86, with most located in Downtown’s medical district. Of the 14 NICU units in Cook County, only one facility near the South Side and two near the West Side — all outside of the city — specialize in high-risk pregnancies.
• The Chicago maternal morbidity rate is 74.1 per 10,000 deliveries, but the rate ranges from 15.6 to 172.8 per 10,000 by ZIP code. Some of the highest rates are in ZIP codes without hospitals and in ZIP codes with lower numbers of practicing OB-GYN physicians.
• Areas with high rates of inadequate pre-natal care — care that begins after four months of gestation — coincided with areas highly concentrated on the South and West sides with few or no registered OB-GYN providers and areas that are farther away from hospitals with a high capacity for maternal and infant care.
• Living on the South and West sides was also correlated with higher rates of infant deaths, higher rates of preterm births (before 37 weeks) and higher rates of low (less than 2,500 grams) and very low (less than 1,500 grams) birthweights.

The findings are no surprise to Karie Stewart, a certified nurse-midwife with UI Health. She and fellow staffers at the Auburn Gresham-based clinic have seen an influx of patients seeking care unavailable to them closer to home.

“I don’t have access to obstetricians or [nurse practitioners with advanced nursing degrees] where I’m working, and so that makes it very difficult for me, because then I’m seeing people who are really high risk. Not that it bothers me … but the majority of the midwives are not comfortable doing high-risk care because that’s not what they were trained in,” Stewart said. “So you have a population that also has lots of social determinant needs, and we are stretched thin with staff.”

Stewart said exhaustion is the main reason so many health care professionals are leaving the industry. Having to manage prenatal care during the pandemic and shift from telehealth visits back to in-office ones was a hard transition for many. And the lack of support and resources didn’t help, Stewart said.

The numbers reflect the reality: According to the study, the highest concentration of OB-GYN physicians is in the Downtown and Medical District areas. While patients on the South and West sides may have the option to seek care at federally qualified health centers in their communities, those centers do not offer all of the same services and are rarely equipped to handle high-risk cases.

‘Filling In The Gap For Expectant Parents’

But solutions are out there. Stewart believes that “incentivizing good health” would be a start.

“We have to provide the resources so expectant mothers can actually have a good chance of having a good health outcome,” Stewart said. “We see a lot of these patients on the South and West sides that don’t have access to good nutrition or access to appropriate transportation. If they have insurance, their insurance carriers aren’t informing them of all the resources that they could utilize based on their carrier.

“We do a lot of that education within the clinic, and we have case managers and a nutritionist. I’ve purposely done those things because the area that I serve is a desert. If you were incentivizing clinics that support and highlight those types of things, you’ll have better outcomes.”

Stewart is one of the industry veterans behind the Melanated Group Midwifery Care model, a “multi-pronged strategy” designed to improve the Black birthing experience from prenatal to postpartum care. The model received a $7.1 million grant from the Patient Centered Outcomes Research Institute two years ago, allowing for the hiring of Black midwives, doulas and nurse navigators at UI Health.

Stewart’s model allows patients to start with midwifery care. From there, she and her team determine whether the patient needs to be co-managed by the obstetrician or the maternal fetal medicine physician at UI Health’s main campus.

The majority of pregnant people remain at Auburn Gresham, where they have access to Stewart, a caseworker and a nutritionist, all of whom are ready to address any immediate needs, Stewart said. The nutritionist can make sure pregnant people are able to receive WIC or help them apply for Temporary Assistance for Needy Families. Expecting parents also get a doula who will help them postpartum.

Filling in the gaps and providing wraparound services also improves outcomes, whether it’s giving a pregnant mom money to take a bus for an ultrasound appointment or ensuring an expectant parent has support in a medical emergency, Stewart said.

She recalled a time when one of her patients had an emergency while she was at home with two small children with her partner away.

“She just started bleeding a lot. She didn’t have a car nor anyone to call to support her children while she decided to go to the hospital. She called her doula, the doula that we provided, and her doula came to the house and watched the children while the ambulance took her to the hospital,” Stewart said. “She was able to get the care she needed, which saved her life because that could have been really bad. She didn’t have to make the decision of choosing to either go to the hospital and assess her needs or leaving her children at home by themselves.

“She had support with the program that we provided. She was able to get a ride home, and know that when she got home, her kids were safe because the doula was there.”

There are glimmers of hope that this kind of care could be expanded.

Earlier this week, Gov. JB Pritzker signed the birth equity initiative, which calls for providers of state-regulated health care plans to cover crucial pregnancy and postpartum services, like midwives and doulas, for up to 12 months after birth. Stewart, who was on hand for the occasion, told Block Club the law is a sign of progress.

“That’s huge step that they put funding to funding doulas, monies for midwives and also other resources that are needed for the community. Therefore you’re putting money into the workforce, allowing other individuals to be able to assist in caring for this population and having better outcomes,” Stewart said.

On the West Side, doulas affiliated with Marillac St. Vincent in Garfield Park are helping vulnerable patients by offering round-the-clock assistance as they navigate their pregnancies through Project Hope, educating them on what they need to know and how to advocate for themselves during doctor visits. The 29-year-old doula program helps young mothers in the community and those detained at Cook County Jail.

And on the Far Southeast Side, a midwife is working to create a “utopia of Black birth workers” with nurses, a physician collaborator, pediatricians, nutritionists, social workers and childbirth and parenting doulas and educators, all of whom will assist in providing comprehensive care to patients at a birthing center, eliminating one more maternity desert. People interested in midwifery will be able to receive training there as well.

Listen to the Block Club Chicago podcast: