WHEN IT COMES to health care, it’s easy to assume Massachusetts has it all figured out. Just look at any national ranking, and more often than not, the state is right at the top of the list for things like affordability and access. In recent years, the Bay State has even been ranked first in the country for women’s health and reproductive care.

Yet in the last nine months, it has lost two maternity units — one at Mercy Medical Center in Springfield and another at Merrimack Health’s Methuen campus. Overall, there have been 13 maternity service closures in Massachusetts since 2010.

These kinds of closures and consolidations are part of a concerning trend seen nationwide, and yet, unlike many other states, Massachusetts technically has no maternity care deserts, which are counties without obstetric providers and hospitals or birth centers offering obstetric care.

Each county in Massachusetts has been deemed “full access” by the nonprofit advocacy and maternal health research group March of Dimes, meaning it has two or more hospitals or birth centers offering obstetric care, and 60 or more obstetric clinicians per 10,000 births.

Yet on the ground, women still report that they have given birth in ambulances, emergency rooms, and generally have felt less safe after their local maternity units closed.

This week on The Codcast, CommonWealth Beacon reporter Hallie Claflin talks with Alecia McGregor, assistant professor of health policy and politics at the Harvard T.H. Chan School of Public Health, and Katie Murphy, president of the Massachusetts Nurses Association. They dig into the consequences of recent maternity unit closures, discuss where Massachusetts actually stands in terms of maternal health care access, and detail what power the state has, if any, to regulate health service closures and consolidations. 

“What you’ll see more frequently is that hospitals will only discontinue obstetrics while the remainder of the hospital remains in operation,” McGregor said. “Hospitals tend to see labor and delivery as a money loser. Running a labor and delivery unit is extremely costly because it has very high fixed costs, and it requires around-the-clock staffing.”

McGregor pushed back on the notion that Massachusetts has no maternity desserts.

“These measures are county based, and in a place like Massachusetts, there’s 14 counties. That’s too broad of a measure to really capture the inequities in where hospital obstetric units are and where they’re more likely to close,” McGregor said. “We definitely need a more precise measure of maternity care deserts in the state.”

When a hospital in Massachusetts decides to close or shutter services within their facility, there are several requirements — outlined by the Department of Public Health — that it must fulfill before it can complete the closure. During this process, DPH often determines that the hospital or unit is an essential service “necessary for preserving access and health status within the hospital’s service area.” Beyond that recognition, the state has almost no authority to prevent the closure.

“Thirteen closures, and in every single one of them, the Department of Public Health deemed these services or hospitals essential to the community,” Murphy said. “The state has no power whatsoever to compel these services to be maintained. It’s different in different states, but that’s the case in Massachusetts. … We have filed legislation this session and in other sessions to give DPH far greater latitude in keeping these services open.”

In this episode, Claflin, Murphy, and McGregor discuss why maternity units are more likely to be shuttered than other units (2:13), the consolidation of maternal health services in Massachusetts (12:27), and how Gateway Cities are particularly vulnerable to these closures (19:24).