California is rapidly losing birthing hospitals. More than 1 in 5 closed between 2019 and 2020. This year, hospitals in Poway, Oceanside and El Centro closed their maternity wards.
Hospital closures may be contributing to a startling statistic: Last year, more than 1 in 10 babies in the United States were born before their due date.
It’s the highest U.S. preterm birth rate March of Dimes has ever reported, according to Jessica Wade, Maternal Infant Health Initiatives manager for March of Dimes in San Diego and Imperial Counties.
San Diego saw a much smaller increase in preterm birth rate — from 8.6% to 8.8% – but Wade said it’s still concerning.
“It's alarming because within California, we have so much access, right — doula access, access to midwives and obstetric care — and our numbers are worsening,” Wade said.
Wade’s own son, Marlon, was born premature in what she describes as a low-access area outside Los Angeles. During his 143 days in the neonatal intensive care unit, Wade said her family lost everything.
“House, cars, jobs — like, everything we could lose, we lost,” Wade said. “And there were really days where we were like, ‘OK, are we going to take the train to see our son who was 90 miles away or are we going to get groceries?’”
Fewer providers in an area means it takes more money and time to see a doctor. And those barriers hit hardest among Black and Indigenous people in low socioeconomic areas, who are far more likely to receive inadequate care during pregnancy.
Wade described how these barriers can impact care: A pregnant mother in a historically redlined neighborhood finds a way to obtain childcare and takes the bus to a provider in a low-access area. The bus stops in her area don’t have covers for shade. It’s over 100 degrees. When she finally arrives at the crowded waiting room, she faces a long wait for the in-demand maternity doctor.
When she finally sees the doctor, she wants to mention that she’s dizzy at times, gets hot flashes and her feet are swelling — signs of preeclampsia. But the doctor is rushed and she needs to catch her return bus and take care of her family. She leaves without mentioning the symptoms, and with a higher risk of giving birth early.
Sometimes, financial and transportation barriers prevent people from seeking prenatal care altogether. As a doula, Wade said she’s worked with women who never visited a doctor during their pregnancy.
The March of Dimes report marks Imperial County as a low access area, and that was before the closure of the maternity ward at El Centro Regional Medical Center.
Though San Diego County is marked as full access, county-level data can mask disparities between ZIP codes — and between the quality of care people receive even when they do have access. Black women die during birth more than 2.5 times as often as white women.
County-level data can also miss nuances, like how many people along the border cross into Mexico for maternity care.
Wade said they are hoping to provide even more precise numbers in the coming years.
