As maternal mortality skyrockets in the United States, a federal program created to improve rural maternity care has bypassed Black mothers, who are at the highest risk of complications and death related to pregnancy.<\/p>\n

The grant-funded initiative, administered by the Health Resources and Services Administration, began rolling out four years ago and, so far, has budgeted nearly $32 million to provide access and care for thousands of mothers and babies nationwide \u2014 for instance, Hispanic women along the Rio Grande or Indigenous mothers in Minnesota.<\/p>\n

KFF Health News found that none of the sites funded by the agency serves mothers in the Southeast, where the U.S. Census Bureau shows the largest concentration of predominantly Black rural communities. That omission exists despite a White House declaration<\/a> to make Black maternal health a priority and statistics showing America\u2019s maternal mortality rate has risen sharply<\/a> in recent years. Non-Hispanic Black women \u2014 regardless of income or education level \u2014 die at nearly three times the rate of non-Hispanic white women.<\/p>\n

\u201cThere\u2019s a responsibility to respond to the crisis in a way that is more intentional,\u201d said Jamila Taylor, chief executive of the National WIC Association, a nonprofit advocacy group for the federal Special Supplemental Nutrition Program for Women, Infants, and Children.<\/p>\n

\u201cWhy isn\u2019t HRSA stepping up to the plate, especially with this rural moms\u2019 program?\u201d Taylor said. According to a 2021 analysis of federal data, Black women living in rural areas also are more likely to die<\/a> or experience more severe health complications during delivery than white women living in rural areas.<\/p>\n

Experts say the failure of HRSA\u2019s Rural Maternity and Obstetrics Management Strategies Program, or RMOMS, to reach predominantly Black communities in the rural South reveals structural inequities and underinvestment in a region where health care resources are scarce and have deteriorated.<\/p>\n

\n\t \n\t<\/iframe>\n<\/p>\nThe steady closure of hospitals in the region and widespread medical staffing shortages have hindered the ability of cash-strapped agencies and care providers to provide more than essential services. Many \u201cdon\u2019t have sufficient resources\u201d to apply for the grants, said Peiyin Hung, deputy director of the University of South Carolina\u2019s Rural and Minority Health Research Center. Hung is also a member of the health equity advisory group for the maternal grant program.<\/p>\n\u201cRMOMS really means to invest in the most underserved and the most disadvantaged communities,\u201d she said, but because the program demands applicants have a network of hospitals and other care providers, she said, \u201cthe odds are not there for them to even try.\u201d<\/p>\nHung said she favors basing the awards on need and not solely on the quality of an application.<\/p>\nWhere the Help Is Going<\/strong><\/p>\nThe rural program launched in 2019 and has awarded 10 maternal health grants nationwide to bolster telehealth and create networks between hospitals and clinics. Despite the disruption of care due to the covid-19 pandemic, the program\u2019s <a href=\"https:\/\/kffhealthnews.org\/news\/article\/new-mexico-maternity-care-deserts-rural-funding-cliff\/\">earliest grant winners<\/a> helped more than 5,000 women get medical treatment and recorded a decrease in preterm births during the second year of implementation, the agency reported.<\/p>\nWhen KFF Health News first asked Tom Morris, associate administrator for rural health policy at HRSA, about the lack of grants in the rural South, he said the agency has an \u201cobjective review process\u201d and regularly reviews the program to ensure it reaches the people who need it most.<\/p>\n\u201cThe rural rates of maternal mortality for African Americans is a real concern,\u201d Morris said, adding, \u201cI think you raised a good point there, and something we can focus on moving forward.\u201d<\/p>\nSo far, the maternal grants have gone to health care providers in Arkansas, Maine, Minnesota, New Mexico, South Dakota, Texas, Utah, and West Virginia, as well as two awards in Missouri.<\/p>\nAmong the initial 2019 awardees, Texas reports that 91% of people it served were Hispanic; New Mexico reported 59% of recipients were Hispanic; and the Missouri project, which was in the southeastern part of the state known as the Bootheel, said 22% of beneficiaries were Black patients. In all cases, the majority were Medicaid enrollees. No data was available for other grant awardees. (Hispanic people can be of any race or combination of races.)<\/p>\nStates across the rural Southeast have not expanded Medicaid coverage to larger numbers of lower-income residents, which often means lower shares of patients have health coverage.<\/p>\n<div class=\"wp-block block--newsletter \" data-type=\"kaiser-health-news\/newsletter\" data-align=\"center\" style=\"\">\n<h4 class=\"newsletter__title\">\n\t\t<a href=\"https:\/\/kffhealthnews.org\/email-signup\/\"> \n\t\t\tEmail Sign-Up\t\t<\/a> \n\t<\/h4>\n\n\t\tSubscribe to KFF Health News’ free Morning Briefing.\t<\/p>\n<\/div>\nWhere Help Is Most Needed<\/strong><\/p>\nThe lack of Medicaid expansion in the region is “all the more reason funding should be going to these areas,\u201d said the WIC association\u2019s Taylor. She said the program\u2019s failure to reach into the southeastern U.S. seems \u201cincredibly odd.\u201d<\/p>\n\u201cThe South is a hotbed \u2014 to be quite honest \u2014 of a whole host of chronic diseases and health challenges, particularly for people of color,\u201d Taylor said.<\/p>\nTaylor, who previously worked on similar programs with community-based organizations while at the Century Foundation, said grant applications are often long and tedious and require intense data collection, adding to the \u201creal challenges and barriers in the process of applying for the grants in the first place.\u201d<\/p>\nRep. Robin Kelly (D-Ill.), whose district spans rural and urban areas, said it is her experience that \u201csome of the neediest places don\u2019t apply for the grants because they don\u2019t have the personnel.\u201d<\/p>\n\u201cThere needs to be special outreach,\u201d said Kelly, who created legislation in 2018 to extend postpartum care after hearing from a constituent. \u201cWe need to take the extra steps that mean saving women\u2019s lives.\u201d<\/p>\nSeveral current grant winners said the federal agency does provide extensive technical assistance and is responsive to questions and concerns \u2014 but they also described how difficult it was to win the grants, which amounted to $1 million or less for <a href=\"https:\/\/www.hrsa.gov\/rural-health\/grants\/rural-community\/rmoms\/fy22-cohort\">last year\u2019s winners<\/a>.<\/p>\n\u201cIt\u2019s an intimidating grant to apply for,\u201d said Johnna Nynas, an obstetrician and gynecologist who wrote the maternal grant application for Sanford Bemidji Medical Center in Minnesota.<\/p>\n\u201cI don\u2019t want to admit how much of my own personal time I dedicated to this grant, writing it,\u201d she said. Sanford won the grant in 2021.<\/p>\nUnlike applicants from smaller, cash-strapped health organizations, Nynas was able to solicit help from the internal grant team at Sanford Health, which operates a regional system including a health plan as well as hospitals, clinics, and other facilities in the Dakotas, Iowa, and Minnesota.<\/p>\nNynas said four hospitals in the remote region of northern Minnesota, where Bemidji is located, have closed their labor and delivery units in recent years, leaving residents \u2014 including a significant number of Indigenous women \u2014 to drive 60 miles or more one way for care.<\/p>\nMeeting an application requirement to create a network that includes specific health clinics as partners in the grant was \u201cthe biggest challenge,\u201d Nynas said, adding \u201cwhen you look at the map, those can be very difficult to find.\u201d<\/p>\nTry, Try Again<\/strong><\/p>\nIn South Dakota, Avera Health\u2019s application stalled for two years because of grant criteria requiring state Medicaid agencies to sign on as network partners, said Kimberlee McKay, an OB-GYN and the program director for the South Dakota grant. Avera Health spans Iowa, Minnesota, Nebraska, North Dakota, and South Dakota.<\/p>\nIt wasn\u2019t until the third round, McKay said, and after \u201cthe climate around maternal health had changed,\u201d when the state Medicaid agency committed to fully partnering on the maternity care grant.<\/p>\nSouth Dakota voters adopted Medicaid expansion in late 2022 and will implement it this summer. Avera\u2019s South Dakota program will use grant money to reach <a href=\"https:\/\/www.hrsa.gov\/sites\/default\/files\/hrsa\/rural-health\/grants\/2022-rmoms-directory-final.pdf\">more than 10,000 pregnant patients<\/a> in the eastern part of the state and the region\u2019s tribal communities.<\/p>\nAmong the previous grant winners, only the Texas winner is from a non-Medicaid expansion state. HRSA spokesperson Elana Ross said 10 of 38 applications won grants since 2019. She declined to release a list of unsuccessful applicants, citing privacy concerns.<\/p>\nRoss said the requirement to partner with Medicaid \u201cincreases the likelihood that the pool of applicants, if selected, will be able to sustain services at the end of federal funding.\u201d Medicaid, she noted, pays for nearly half of all births nationally and a greater share of births in rural areas.<\/p>\nThe goal for the grants is that applicants can keep the program operating even after several years of federal funding runs out, HRSA officials said.<\/p>\nStoking Change<\/strong><\/p>\nIn May, after KFF Health News began reporting this article, the agency released <a href=\"https:\/\/www.documentcloud.org\/documents\/23842870-v2modified-6-7-23forhp-hrsa-23-049-uk9-rmoms-final?responsive=1&title=1\">a new call for applicants<\/a> and relaxed requirements. Only two awards will be given, and the applications, which demand detailed network plans, are due July 7.<\/p>\n<a href=\"https:\/\/www.grants.gov\/web\/grants\/view-opportunity.html?oppId=340917\"\/>In an emailed statement released after announcing the more flexible expectations, Morris said the federal agency\u2019s mission was to provide care for \u201cthe highest-need communities, and that means dedicating significant funds towards addressing the Black maternal health crisis.\u201d The agency will no longer require state Medicaid programs to be partners on initial applications. It also loosened language about which clinics needed to be in the network.<\/p>\nAnd in perhaps the most significant shift, the agency said it will use newly created criteria to determine \u201careas of greatest need.\u201d Alabama, Louisiana, and Mississippi all qualify as areas with shortages of maternity health care providers, according to <a href=\"https:\/\/www.grants.gov\/web\/grants\/view-opportunity.html?oppId=340917%22%20the%20funding%20notice\">the funding notice<\/a>.<\/p>\nKelly, who works on Congress\u2019 <a href=\"https:\/\/robinkelly.house.gov\/media-center\/press-releases\/reps-robin-kelly-young-kim-announced-co-chairs-bipartisan-maternity\">bipartisan maternity care caucus<\/a>, said of the lack of grants in the rural South: \u201cMoney matters, resources matter.\u201d<\/p>\nDespite the government-wide focus on maternal care, it wasn\u2019t clear whether the rural program would award new grants in 2023. In April, Morris told KFF Health News the agency was \u201ctrying to figure out if we have enough funding to support our existing grantees and do a new competition.\u201d<\/p>\nThe rural maternity program\u2019s initial fiscal year 2023 budget was $8 million \u2014 down from $10.4 million the year before, according to the <a href=\"https:\/\/www.hrsa.gov\/about\/budget\/operating-plan\">agency\u2019s operating plan<\/a>. The release of grants in May came after the federal agency found an additional $2.4 million in its internal budget.<\/p>\nEven so, Kelly said, she \u201cwould love to see more money being put toward it\u201d as well as evaluations of \u201cwhere the money is being spent and where the holes are.\u201d<\/p>\n<aside class=\"meta-authors meta\">\n\n\t\t\t\t\t\t\t\t\t\t\tSarah Jane Tribble: <\/span> \n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/kffhealthnews.org\/news\/article\/black-rural-southern-women-at-gravest-risk-from-pregnancy-miss-out-on-maternal-health-aid\/mailto:sjtribble@kff.org\">sjtribble@kff.org<\/a>,\t\t\t\t\t\t\t\t\t\t\t<a href=\"http:\/\/twitter.com\/SJTribble\" target=\"_blank\" rel=\"noopener\"> \n\t\t\t\t\t\t\t@SJTribble<\/a>\n\t\t\t\t\t\t\t\t\t<\/p>\n<\/aside>\n<section class=\"block--category-tag-list \">\n<div class=\"category-tag-list__content-wrapper\">\n<h3 class=\"block--category-tag-list__title\">\n\t\t\t\tRelated Topics\t\t\t<\/h3>\n\t\t\t\t<a class=\"category-tag-list__contact-link\" href=\"https:\/\/kffhealthnews.org\/contact-us\/\"> \n\t\t\tContact Us\t\t<\/a> \n\t\t<a class=\"category-tag-list__tip-link\" href=\"https:\/\/kffhealthnews.org\/tips\/\"> \n\t\t\tSubmit a Story Tip\t\t<\/a>\n\t<\/div>\n<\/section><\/div>\n<script async src=\"\/\/platform.twitter.com\/widgets.js\" charset=\"utf-8\"><\/script><\/p>\n","protected":false},"excerpt":{"rendered":"As maternal mortality skyrockets in the United States, a federal program created to improve rural maternity care has bypassed Black mothers, who are at the highest risk of complications and death related to pregnancy. The grant-funded initiative, administered by the Health Resources and Services Administration, began rolling out four years ago and, so far, has […]<\/p>\n","protected":false},"author":1,"featured_media":1418,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-1417","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-industry"],"_links":{"self":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/1417","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1417"}],"version-history":[{"count":1,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/1417\/revisions"}],"predecessor-version":[{"id":1419,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/posts\/1417\/revisions\/1419"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=\/wp\/v2\/media\/1418"}],"wp:attachment":[{"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1417"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1417"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthynewsusa.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1417"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}