Monroe County has full access to maternity healthcare, according to a report from maternity and child health nonprofit March of Dimes. But Morgan, Owen and Brown Counties have little or no access, forcing residents to navigate increased travel times for delivery or prenatal care.
Indiana’s struggling rural hospitals are cutting their birthing units, leaving pregnant women to travel further for care during delivery and prenatal appointments. That limited access to maternity care can contribute to poor health outcomes.
Jack Turman, a professor in the Department of Pediatrics at the IU School of Medicine, said the availability of maternal healthcare in south central Indiana becomes increasingly limited further from Monroe County.
“Monroe County has very good supports,” Turman said. “But when you get to places that are more distant and more rural, it really becomes problematic.”
Laney Martlage is a junior at IU majoring in human biology and an intern for Tandem, a local nonprofit that provides inclusive maternal healthcare. She said these low-access areas drive people seeking care to Bloomington.
“Monroe County is kind of an island,” Martlage said. “Having Tandem in this area and having the hospitals in the area is a really big deal because everybody comes here to have their kids.”
Martlage was born in 2004 in Martinsville at her mother’s local hospital. That facility closed its birthing unit soon after.
“By the time she had my sister three years later, which would have been 2007, they had closed that down,” Martlage said. “Her only option was to drive all the way to Bloomington and give birth there.”
This matches a national trend of rural birthing unit closures.
Jessie Reynolds, a family medicine physician specializing in rural health, graduated from the IU School of Health in 2005. Two of the rural hospitals she’s worked at since, in different states, have closed their birthing units.
Reynolds said these hospitals often survive on a “shoestring budget,” meaning the personnel costs of running a birthing unit can be financially unsustainable.
“At some point, you can't let your OB unit take down the whole hospital,” Reynolds said.
Without a birthing unit at their local hospital, Reynolds said her patients drove 45 minutes or more to deliver, often in inclement weather or unsafe road conditions. She delivered multiple children outside of a birthing unit because her patients could not reach a hospital with a birthing unit in time.
Reynolds said she used to keep a medical kit in her car in case she encountered a pregnant patient going into labor on the side of the road.
“You see a car flashing on the side of the road, you definitely were looking to see if it was your patient,” Reynolds said.
In much of the area around Monroe County, including in Brown, Morgan and Owen counties, residents must travel upwards of 19.5 miles on average to reach the nearest birthing hospital. Longer travel times for maternity care correspond with increased maternal morbidity.
These long travel times can also burden people trying to attend prenatal care appointments, according to a 2023 report by the Indiana Maternal Mortality Review Committee. The report also found that inadequate prenatal care –– including people who did not attend the recommended number of prenatal appointments –– contributes to Indiana’s maternal mortality rates.
A 2023 report by March of Dimes found 15.5% of pregnant individuals in Indiana did not receive adequate prenatal care, which is above the U.S. average.
Turman said women often miss prenatal care appointments due to a lack of transportation, housing, childcare or money. Women facing domestic abuse or financial dependency may also have limited ability to seek or pay for care.
Turman also serves as the director of the Grassroots Maternal and Child Health Initiative, which aims to improve health outcomes by bolstering social systems. He said policies supporting pregnant women and children are necessary to improve maternity care outcomes.
“I merely wish that we could come to a place where they are really prioritized for their health and well-being in every way,” Turman said. “Because it's well known that when you do that, guess what happens? All things get better.”
