By Leah Shepard / Broadcast version by Nadia Ramlagan reporting for the Kent State-Ohio News Connection Collaboration.

In Ohio, 13 of 88 counties are maternity care deserts, affecting approximately 97,000 women, according to data provided by March of Dimes. 

A county is classified as a maternity care desert if there are no hospitals providing obstetric care, no birth centers, no OB-GYN’s and no certified nurse midwives, according to March of Dimes. Bianca Zarders, maternal and infant health manager for the Cleveland Market Branch of March of Dimes, said 4,118 babies were born last year to Ohio mothers who live in maternity care deserts.

“In Ohio and on a national scale, a lot of the research shows that a lot of these women may have to drive 30, 40, 50 minutes to get to their nearest birthing hospital,” Zarders said. “And that is so problematic too, because if they’re struggling to pay for gas, or they have multiple kids who are at day care or in school, finding just the time to actually go to a prenatal appointment or to give birth and having to drive 50 minutes to get somewhere is insane.”

The dearth of maternity care in the state is getting worse, said Natasha Takyi-Micah, public policy and external affairs associate at the nonprofit Center for Community Solutions in Cleveland.

“And a few weeks ago, University Hospitals in Ashland announced that they were closing their maternity department,” Takyi-Micah said. So pretty much, that county does not have any hospitals that offer labor and delivery services unfortunately.”

The closing of the maternity department at Ashland comes eight months after University Hospitals closed their maternity department in Portage County in order to consolidate labor and delivery services at UH Geauga Medical Center in Geauga County. 

In a press release, University Hospitals said that declining birth rates and staffing shortages are both reasons for the closing the maternity department in Portage County. They said in July that the Ashland branch is closing for the same reasons. 

“The reason why a lot of hospitals are closing their labor and delivery departments or maternity wards is because of what happened during the pandemic,” Takyi-Micah said. “It seems the pandemic exacerbated many problems that came to staff shortages in the hospitals, and also there was a decline in births.”

Dr. Maria Phillis, an OB-GYN and member of the American College of Obstetricians and Gynecologists, said maternity care deserts force some patients to travel unusually far for appointments, especially if they need specialized care.

“One of our notable things we have to fill gaps for is higher-level care,” she said. “So for example, at one of the institutions that I’ve worked at, we had a patient with significantly poorly controlled diabetes who was coming essentially more than an hour and a half for high-risk appointments and wasn’t able to routinely travel that distance.”

Phillis said that many of these patients travel from very rural areas where obstetric care is unavailable.

Zarders, who works in research, policy and legislation for the March of Dimes as well as community outreach, said the lack of maternity care coupled with chronic health conditions, like diabetes, hypertension and smoking, often lead to poor childbirth outcomes and preterm births.

She said other widespread issues affect whole communities. 

“Another overarching theme is community level issues,” Zarders said. “Like socioeconomic status or environmental factors. Those also fuel the disparity when it comes to receiving adequate prenatal care, especially in communities of color.”

Zarders said that at some hospitals, women are turned away entirely because of lack of care, and that this is something that happens on a national scale.

“I recently heard a story where a woman ended up in an emergency room because she was in labor,” Zanders said. “And the nearest hospital just had an emergency room. And she was actually denied care because they didn’t have an OB person present. And so they actually asked her to go to another hospital.”

Takyi-Micah said the Center for Community Solutions is working to influence policy at the state level to alleviate this problem. 

“We just wrapped up the state budget,” she said. “We have been advocating for doulas to be reimbursed through Medicaid so more people have access to them, since they are one of the solutions to reduce the infant and maternal mortality crisis. So, that language is now included in the budget.”


This collaboration is produced in association with Media in the Public Interest and funded in part by the George Gund Foundation.


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World Hepatitis Day is this Sunday, and for the Oregon Health Authority, it's an opportunity to promote its plan to eliminate hepatitis across the state.

Released in March, the plan includes major goals and strategies to limit the spread of hepatitis A, B and C over the next six years. It's gotten new attention after 2,400 patients in Oregon hospitals were potentially exposed to hepatitis and HIV earlier this month.

Concerns are high, but epidemiologist Dr. Dean Sidelinger, Oregon's state health officer, said people should be aware of the threats of hepatitis, but not anxious.

"In day-to-day times, people should feel safe and confident in going to the doctor," he said. "The risk of exposure to these viruses is extremely low in most cases."

Hepatitis is inflammation of the liver, and contagious viruses are among the causes. Sidelinger said he's confident Oregon has the technology and resources to fully eliminate the threat.

While many people may have heard of hepatitis, they may not fully understand how prevalent it is in their communities. According to OHA data, the proportion of chronic hepatitis C cases among people in their 20s tripled between 2010 and 2019.

Sidelinger said there's a good chance most Oregonians know someone who is affected by chronic hepatitis.

"It can seem out of the blue to be talking about hepatitis and [a] hepatitis awareness day, but this is a disease that affects many individuals," he said. "But the good news is, everyone can take steps to protect themselves."

The OHA says you can help prevent the spread of hepatitis by washing hands and fresh produce, staying current on vaccinations, avoiding sharing needles, and getting tested regularly. These tips and more are part of the state's plan to eliminate hepatitis by 2030.


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CoveredCA announced Wednesday that the average premium for plans on the marketplace will rise 7.9% in 2025, but subsidies are expected to blunt the impact and even lower costs for many consumers.

The Biden-Harris administration's Inflation Reduction Act caps premiums at 8.5% of income for many, and goes even further for those with low incomes.

Rachel Linn Gish, director of communications for the nonprofit Health Access California, said the state has put the federal funds to good use.

"Because of this financial help," she said, "California has been able to take even further steps to lower costs for many CoveredCA enrollees by eliminating deductibles and reducing copays for many health services such as doctors' visits, lab work, generic drugs."

However, the enhanced premium subsidies in the IRA will expire next year, sending costs soaring unless Congress extends them. If not, Gish said, she expects premiums to rise 60% to 80%, costing thousands more per year. Opponents of the extension have cited the need to limit federal spending.

Gish said if the federal premium help ends, people could start seeing much higher deductibles.

"Without the federal assistance, California stands to lose $1.7 billion in assistance, which the state can only backfill a fraction of," she said, "which means consumers could again see deductibles of $5,000 or more."

Other big changes are on the way. Starting Nov. 1, about 40,000 income-eligible DACA recipients in California will be able to apply for premium subsidies through Covered California.

Connecticut insurance companies are requesting rate increases. Companies want a more than 8% increase for individuals and an almost 12% increase for small groups. However, insurance costs are already problematic for residents. A 2022 survey shows 46% of people delayed important medical care due to coverage costs.

Liz Dupont-Diehl, associate director of the Connecticut Citizen Action Group, said unaffordable insurance is all too common.

"It is an unfortunate American right of passage to spend hours a week appealing claims denials, or dealing with rising copays, and surprise costs. Even those of us lucky enough to think we have good coverage are continually surprised by hings that are not covered," she said.

Of the legislative solutions lawmakers can take, polls show voters across party lines support the government setting limits on out-of-pocket medical care costs for people with insurance.

Connecticut's Insurance Department will host an informational meeting for people to share their experiences and hear testimony. It will be held from 9 a.m. to 1 p.m. on August 20 at the Legislative Office Building in Hartford and over Zoom.

One way Connecticut's General Assembly can better regulate insurance companies is by increasing transparency surrounding pharmacy benefit managers. A recent Federal Trade Commission report finds the six largest pharmacy benefit managers manage 95% of the country's prescriptions.

Dupont-Diehl said this can help people better understand why certain claims get denied.

"We would be interested in knowing exactly which claims are denied based on ZIP code, based on race and ethnicity, based on age, based on gender," she continued.

She notes that much of what needs to be done to fix health care can be done at the federal level, although states can take the lead. Part of Connecticut's 2023 budget calls for the state's Insurance Department to work with the Office of Health Strategy to study ways to make care more affordable.