Increasing Access to Midwifery Care in Underserved Communities

Maternal health disparities remain a pressing issue in the United States. According to the CDC, Black, Indigenous, and other women of color face significantly higher rates of maternal and infant mortality. Rural communities also experience barriers to quality maternity care, often having to travel long distances to access providers. 

Midwifery care can help bridge these gaps by offering personalized, culturally competent care that prioritizes continuous support, education, and evidence-based practices. Midwives provide holistic prenatal, birth, and postpartum services, reducing the likelihood of complications through early intervention and comprehensive maternal care.

Maternal & Infant Health Stats

Maternal Mortality

Between 2018 and 2022, Ohio reported a maternal mortality rate of 24.5 deaths per 100,000 live births, totaling 161 maternal deaths during this period.

This rate is higher than the national average and reflects disparities among different racial and ethnic groups.

Severe Maternal Morbidity (SMM)

SMM refers to unexpected outcomes of labor and delivery that result in significant short- or long-term health consequences. In Ohio, the overall SMM rate is 71.9 per 10,000 live births. However, disparities exist:

• Black Women: 112.2 per 10,000 live births

• White Women: 60.5 per 10,000 live births

• Hispanic Women: 67 per 10,000 live births

Infant Mortality

Infant mortality rates in Ohio also reveal significant disparities:

• Overall Rate (2021): 7.0 deaths per 1,000 live births

• Black Infants (2021): 14.2 deaths per 1,000 live births

• White Infants (2021): 5.4 deaths per 1,000 live births

These statistics indicate that Black infants in Ohio are nearly three times more likely to die before their first birthday compared to White infants.

Preterm Births

Preterm birth rates in Ohio also vary by race and ethnicity:

• All Races: 11%

• White: 10%

• Black: 15%

• Hispanic: 11%

• Asian: 11%

Low Birthweight Infants

The percentage of low birthweight infants (less than 2,500 grams) also shows disparities:

• All Races: 9%

• White: 7%

• Black: 15%

• Hispanic: 8%

• Asian: 10%

Barriers to Midwifery Care in Underserved Communities

Despite the benefits of midwifery care, several challenges hinder access in marginalized communities:

• Legal and Regulatory Restrictions: In some states, midwives face strict licensing laws or lack integration into mainstream healthcare systems, limiting their ability to practice independently.

• Medicaid and Insurance Coverage Gaps: Many midwifery services, especially home births and birth center care, are not fully covered by Medicaid or private insurance, making them financially inaccessible for low-income families.

• Shortage of Midwives: Many communities simply do not have enough trained midwives available, leading to limited options for care.

• Cultural and Language Barriers: Mistrust of the healthcare system, lack of culturally competent care, and language differences can prevent families from seeking midwifery services.

Strategies to Increase Access

Expanding midwifery care in underserved communities requires a multi-faceted approach that includes policy changes, community engagement, and investment in training programs.

1. Advocating for Legislative Changes

   • Expanding licensure and practice rights for midwives, particularly Certified Professional Midwives (CPMs) and Certified Midwives (CMs), can help increase availability in all states.

   • Encouraging Medicaid and private insurance reimbursement for midwifery services can make care more financially accessible.

2. Increasing Training and Recruitment

   • Investing in midwifery education programs, particularly for students from underserved backgrounds, ensures that midwives reflect and serve their communities effectively.

   • Offering scholarships, loan forgiveness, and apprenticeship opportunities can make midwifery education more accessible.

3. Expanding Birth Center and Home Birth Options

   • Establishing midwife-led birth centers in maternity care deserts can provide more choices for families who lack hospital-based options.

   • Supporting midwives in home birth practice through funding, training, and legal protections ensures safe, community-based care.

4. Building Trust and Culturally Competent Care

   • Community outreach programs that educate families about midwifery and provide multilingual resources can help bridge gaps in understanding and access.

   • Training midwives in culturally competent care and partnering with doulas and community health workers can enhance maternal support.

Ohio faces significant challenges in maternal and infant health, particularly among underserved communities and minority populations. Disparities in healthcare access and outcomes are evident, underscoring the need for targeted interventions.