Prenatal care in the Black Belt
One of every six pregnant women in Alabama’s Black Belt fails to get proper prenatal care, nearly twice the rate for the rest of Alabama.
Demographics and economics certainly have a role to play in that statistic, but – somewhat surprisingly – so do the doctors; or the lack thereof.
According to data from the Center for Business and Economic Research at the University of Alabama, in all of the 12 counties that make up the Black Belt Region, there were 348 licensed doctors, or 1.5 doctors for every 1,000 residents.
Outside the Black Belt, there are 4.2 doctors for every 1,000 Alabamians.
Trending statistics for obstetric services are even more alarming.
“In 1980, of 67 counties in Alabama, 58 had hospitals that performed obstetrics,” Dale Quinney, Director of the Alabama Office of Primary Care and Rural Health said. “Today, there’s only 32.”
Following the statewide trend, the number of Black Belt Hospitals that perform obstetrics has dwindled further.
“In the Black Belt, the margin is even greater. In 1980, 10 of the 12 counties identified as being in Alabama’s Black Belt delivered babies. Today, there’s only two.”
Currently, Bryan W. Whitfield Memorial Hospital in Demopolis and Vaughn Regional Medical Center in Selma stand with the lone maternity wards in the area.
“There are three primary reasons,” Quinney said of the drop in number of hospitals that berth babies. “One is the natural physician shortage. Two is the cost of medical liability insurance. Third, and probably the biggest reason, is the hospital loses money on obstetrics in the short-term.”
Changes in Medicaid earlier this year jeopardized one of the two remaining facilities as the Demopolis hospital was forced to submit a bid for reimbursement that was far below the cost of services.
Last February, five obstetrics doctors at Bryan W. Whitfield Memorial Hospital agreed to take a 12-percent pay cut to save the department.
“What the state does is, for Medicaid recipients who are pregnant, they have a Medicaid-managed care program,” said hospital CEO Mike Marshall. “Periodically, the state puts the maternity care program out to bid. Providers that had a network in place go in and bid on the right to administer the program.”
In the last bid cycle, Marshall said the hospital was forced to submit a bid that was lower than what it originally planned in order to maintain its maternity care program.
“We had to slash our prices, and as a result, we had to ask our doctors to take a cut in their fee here so that we could keep that program viable,” he said. “If they hadn’t done that, we would have had to close (the OB program), we would have had to lay off five people, and the additional concern that I had was that if we lost the ability to keep those patients at home, we would further erode the volume in our OB program.”
Bringing doctors back
At the root of Alabama’s prenatal care issue lies a lack of doctors in rural areas, but Quinney is working with a program that he hopes will reverse that trend.
The program hopes to attract rural students interested in medicine with designs that once they complete their residency, they will return to their rural homes.
“It’s much more likely that someone from a rural area that will return to a rural area,” he said. “There’s a sense of pride in going back and serving your hometown. We’re just trying to foster that.”
Dr. Erik Lessmann, a family doctor who was of the five who agreed to take the pay cut at Bryan W. Whitfield Memorial Hospital, is also closing his private practice in Demopolis and moving to Montgomery with similar goals.
He’s accepted a position on the faculty at the Montgomery Family Medicine Residency Program, a program designed to train doctors for Alabama.
“We don’t have the doctors we need here,” he said.
Funneling those doctors back to their rural roots, Quinney said, will have a lot to do with resurrecting OB programs across the state – especially the Black Belt – and helping to improve child health statistics.
“While (OB programs) may be a money loser in the short-term, over the long term it’s not,” he said. “There is an invisible bond between someone and the hospital they are born in. People born in a hospital are more likely to use that hospital to receive other care. And over the long-term, the OB program becomes profitable.”
The 2010 Alabama Kids Count Data Book examines county-by-county statistics on several measures of children’s health. The Black Belt Region consistently ranks near the bottom of most categories.
Dr. Don Williamson, state health officer for the Alabama Department of Public Health, said that may be partly due to the demographics of the region. Statistically, African-Americans have a higher percentage of infant mortality and low weight births with a higher occurrence of births to unmarried teens.
The 2010 Kids County Data Book used 2008 data for infant mortality rates. However, Quinney noted that from 2008 to 2009, the statewide infant mortality rate decreased from 9.5 infant deaths per 1,000 live births in 2008 to 8.2 infant deaths per 1,000 live births in 2009.
Also, in 2009 Alabama saw declines in the number of teen births, low birth weight babies and the number of mothers who smoked during pregnancy – all high risk factors for infant mortality.
“We’re making some progress,” Quinney said, “but we’ve got a lot of work to do.”
At 13.3 deaths per 1,000 live births, the infant mortality rate for African-American infants is the lowest the state has recorded, but it is also more than twice the infant mortality rate for white infants.
“It all comes back to the availability to care,” Quinney said. “If the proper care, the proper doctors, are not available, you can’t expect anything to change.”