CHICAGO — Obstetric and Gynecological (OB/GYN) facility closures have significantly negatively affected maternal and infant health on Chicago’s south and west sides, according to a joint report by the American Medical Association (AMA) and Sinai Urban Health Institute, with support from March of Dimes.

The report, titled “From Facilities to Outcomes: A Neighborhood-Level Examination of Maternal and Infant Care Access in Chicago,” highlights the potential impacts of maternity care deserts and measures maternal health care access at a zip code level within the City of Chicago based on three categories: low access, medium access, and full access.

According to the report, low, moderate, and full maternal care access is distributed unequally across the City of Chicago. Most low-access zip codes are located on the south and west sides of the city, while most of the full-access zip codes are located downtown and on the north side of the city.

The report found that since 2018, three OB/GYN facilities that were more convenient for residents of the south and west sides have closed. The number of OB/GYN physicians available to childbearing female residents in those areas ranged from zero to 43, with many of the zip codes on the south and west sides having access to none. These closures require expectant mothers to travel outside of their neighborhoods to receive routine or specialty OB/GYN care.

“The health of medically disenfranchised patients and the health of their babies suffer when pregnant patients don’t have access to care in their communities,” said AMA President-elect Bobby Mukkamala, M.D. “With closures of health care facilities compelling patients to travel for necessary care, patients experience worse health outcomes. Accompanying ramifications include a decrease in recruiting new physicians into particular specialties such as emergency medicine, family medicine and obstetrics in these communities. This has created a cycle of disjointed, disconnected care for patients in these neighborhoods, a higher level of burnout for physicians and physicians leaving the profession altogether.”

“This report mirrors what we have found in the March of Dimes national report, Where You Live Matters: Maternity Care Deserts and the Crisis of Access and Equity. Maternity care is simply not a priority in our health care system. Families in more than one-third of counties in the U.S. have no access to maternity care, putting moms and babies at risk for negative birth outcomes," said Chicago March of Dimes Senior Executive Director, Ashley Thies. "Steps need to be taken now to ensure all moms receive the care they need to have healthy pregnancies and strong babies."

"Our research underscores the unique challenges of maternal health care access in urban areas like Chicago, where social determinants of health play a crucial role,” said Melissa Gutierrez-Kapheim, Director of Health Equity & Assessment Research at Sinai Urban Health Institute. “The use of neighborhood-level data is essential for effectively targeting our limited resources and measuring impact, allowing us to address maternal health disparities.”

A maternal health care access measure was created for the report by combining three variables at the zip code level: 1) the ratio of OB/GYN physicians to number of women of childbearing age (ages 15 to 44) within a zip code 2) severe maternal morbidity and 3) hardship index—a measure of hardship on a community made up of six indicators: crowded housing, poverty rate, unemployment rate, adults with a high school diploma or equivalent, age dependency ratio and per capita income.

The report found that maternal health care access across Chicago coincides with the distribution of race and ethnicity. Most zip codes with low access to maternal health care are not only located on the south and west sides of the city but are also in zip codes with a population of mostly Black residents. The next highest proportion of zip codes with low maternal care access overlapped with zip codes where the majority of residents are Hispanic/Latino.

Additional findings in the report state that:

• The number of obstetric and gynecological beds in Cook County ranges from 12 to 134, and neonatal intensive care units (NICUs) bed capacity in Cook County ranged from eight to 86 with most located downtown, in the medical district. Of the 14 NICU units in Cook County, only one facility on the south side and two on the west side (all outside of the city) specialize in high-risk pregnancies.
• The Chicago maternal morbidity rate is 74.1 per 10,000 deliveries and ranges from 15.6 to 172.8 per 10,000 by zip code and concentrated some of the highest rates occurring in zip codes without hospitals and in zip codes with lower numbers of practicing OB/GYN physicians.
• Areas with high rates of inadequate pre-natal care—care that begins after four months of gestation—coincided with areas (highly concentrated on the city’s south and west side) with few or no registered OB/GYN providers and areas that are farther away from hospitals with a high capacity for maternal and infant care.
• Living on the south and west sides was also correlated with higher rates of infant deaths, higher rates of preterm births (before 37 weeks), and higher rates of low (less than 2,500 grams) and very low (less than 1,500 grams) birthweights.
• Facility closures appeared to have had the greatest impact on those who scored highest on the hardship index. Areas with high maternal morbidity and high infant mortality were also found to be areas facing high social and economic stress.

The joint report makes recommendations to support mothers and their babies including the use of virtual care to bridge in-person appointments, support from foundations and community programs, diversifying the maternal health care workforce and education funding to expand the maternal health workforce.

We will continue to work toward equitable maternal and infant care and quality care for all patients.