Update on Maternity Ward Closure in Chula Vista, CA
Dr. Susanna Chou, M.D., Ph.D.
It is with sadness that I report the closure of the maternity ward at Scripps Mercy Hospital Chula Vista, south of San Diego, is imminent, with a final date of June 23, 2024. Many of the nursing staff have departed for other positions. Local municipalities and community clinics are working to mitigate the impact on the community.
The reality of maternity care in America is that it is a financial loss for hospitals and obstetricians with a higher proportion of Medicaid patients and is considered an “optional” hospital service by the federal government. Nationwide, 41% of maternity care is paid for by Medicaid. The proportion is even greater for Black (64%) and Hispanic (58%) women. 78% of the population lives in a state in which Medicaid rates for obstetrical care are below that of the Medicare standard fee, with California, the most populous state, having one of the lowest relative rates.
More than 400 maternity units closed nationwide between 2006 and 2020. Between 2011 and 2021, 25% of all rural OB units in the U.S closed. 54% of U.S. counties have one or no maternity units. Within more populous urban communities, hospitals that serve more Hispanic and Black patients receive fewer resources and struggle to retain providers and meet costs. Maternity care is therefore becoming increasingly difficult to access for women that are young, Black, Hispanic or poor.
Because complications from maternal disability and poor infant outcomes are a burden largely borne by women, maternity care is one of the greatest causes for health care cost disparities between men and women in young adulthood. The gap also exists for OB/Gyn physicians, with female OB/Gyns seeing more Medicaid patients, and also making 27.7% less, than their male colleagues. In addition, restrictions on credentialling and payment for other birth providers such as midwives and doulas (who are almost exclusively women) limit the pool of birthing providers, especially in poor or underserved communities.
Together with other physicians and nurses in our community, I have been advocating with federal, state and local governments both to provide better support to existing maternity units financially as well as enact safeguards to require assessment of community impacts before closing units.
We must value women’s health as an essential part of human health, and health of all women as a cause for every woman. We must recognize and address systemic sexism in our healthcare financing and delivery, and uplift women who provide empathetic, culturally relevant women’s healthcare.
Dr. Susanna I. Chou is a family practice physician in Chula Vista, CA. Formerly the Associate Medical Director at the Scripps Otay Family Health Center, she chose to start her own practice to get to know her patients better. She graduated with an M.D. from Harvard Medical School and a Ph.D from Harvard University in Biological Chemistry and Molecular Pharmacology.