Plight of pregnant Native women in Montana is one of the worst cases of poor access to obstetric care in the rural U.S.

Native American women in Montana were 20 times more likely than white women in the state to give birth at a hospital without obstetric services, and they had less access to complex obstetric care. So says a study in the Journal of Rural Health, which looks at birth data in the state form 2014 through 2018. It's one of the worst manifestations of an increasing problem in rural America.

"Pregnant women across the rural United States have increasingly limited access to obstetric care, especially specialty care for high‐risk women and infants," the researchers wrote, noting that there has been little research on obstetric access for rural American Indian and Alaskan Native (AIAN) women, "a population warranting attention given persistent inequalities in birth outcomes."

The researchers put their work into context, noting that Black and AIAN women "are two to five times more likely to die from a pregnancy‐related complication compared to white women. Over 2.2 million childbearing‐aged women live in maternity care deserts (a county bereft of a birth center, obstetric provider, and hospital‐based obstetric unit), and another 4.8 million women live in counties with limited access to maternity care. . . . Access to obstetric services has declined, particularly in rural counties with a higher percentage of racial minority women of childbearing age."

AIAN women are in some ways the worst off, the researchers write: "Compared to women of other racial backgrounds, AIAN women comprise the smallest percentage of childbearing‐aged women who live within an hour of their nearest hospital‐based obstetrics services (83.2%, compared to 97.3% for the overall U.S. population of childbearing‐aged women), and that nearest hospital is often one that provides only basic perinatal care." The Indian Health Service "is severely underfunded, contributing to AIAN health disparities." Montana has seven reservations with 12 Native nations.

The research was done by three professors at Montana State University, one at the University of Missouri and an obstetrician-gynecologist for Kaiser Permanente Northern California.