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Maternity health care deserts are growing in Kansas, officials say.

Pregnant women in Douglas County have better access to maternity care than women in much of Kansas, statewide data indicates, especially as compared to rural areas — a growing concern for health officials in the state.

Care for high-risk pregnancies is concentrated in three main urban centers: Kansas City, Topeka and Wichita, according to a report from the University of Kansas School of Nursing. Douglas County residents typically travel up to 30 miles for access to this care — much closer than most in the state.

In Kansas, 75% of ZIP codes are located more than 30 miles from the nearest facility that provides high-risk delivery services. In some cases, women would need to travel more than 280 miles to access such services, and health leaders say that’s a problem.

The KU report, titled “Access to Maternity Care in Kansas,” was produced in collaboration with the Kansas Center for Rural Health with funding from the United Methodist Health Ministry Fund.

In the last decade, many rural hospitals across the country have either closed or stopped offering maternity care services altogether.

“Rural hospitals are considered at risk of closure due to financial vulnerabilities due to declining occupancy rates, fixed costs, market pressures and really just the change of how care is delivered,” David Jordan, president and CEO of the United Methodist Health Ministry Fund, said during a webinar Thursday.

He said that as health leaders are discussing the existing landscape for maternal health care in Kansas, Congress is proposing more than $700 billion in cuts to Medicaid, the government-funded health care program for low-income people.

Anne Dwyer, an associate research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families, said the reconciliation bill currently being considered by Congress was the “largest budget cut to Medicaid in the program’s history.” If passed, it would put immense pressure on state Medicaid programs, she said.

New modeling from consulting firm Manatt Health said an estimated 13,000 people in Kansas would lose Medicaid coverage under the bill and the state would lose an estimated $3.77 billion in total funding over the next 10 years. Currently, the insurance program covers more than 366,000 Kansans.

In 2022, around 41% of pregnant women in Kansas had Medicaid coverage at the time of giving birth, according to the KU report. In Douglas County, 31.36% of pregnancies that year relied on support from Medicaid.

While the bill would directly impact who will be covered by Medicaid, it also would directly impact hospitals, especially those in rural Kansas. Sixty-three rural hospitals are currently at risk, and 87% of Kansas rural hospitals are struggling to survive with existing federal funding, according to the United Methodist Health Ministry Fund.

Jordan said the closures of hospitals and the resulting lack of maternity services are directly correlated with babies being born early, more infants being admitted to neonatal intensive care units and more women dying during pregnancy or childbirth.

Additionally, when rural hospitals close, jobs are lost, creating a “ripple effect” in small communities.

“If the proposed cuts are enacted, the effects would ripple across rural communities and could result in coverage losses, fewer available health care services, fewer jobs and greater hospital financial instability,” Dwyer said.

photo by: Screenshot

Dr. Beth Oller speaks at a webinar hosted by the United Methodist Health Ministry Fund on Thursday, June 12, 2025.

A dive into the data

The leading author of the KU report, Karen Weis, said a common myth is that rural communities have hardly any births compared to more urban areas, but a look at the ratio of births by county and not just by overall population shows otherwise.

Two western counties in particular, Grant and Wallace, had somewhere between 150 to 200 live births per 1,000 residents of reproductive age — ages 15 to 50 — in 2022. This is significantly greater than Douglas County, which had fewer than 50 births per 1,000 residents that same year.

In contrast to LMH Health in Douglas County, neither Grant County nor Wallace County has inpatient obstetric services available, meaning medical care for childbirth or complications during pregnancy.

According to the presentation on Thursday, 61.4% of counties in Kansas do not have an obstetrician-gynecologist, and where there are OB/GYNs, the number is limited. Douglas County is among eight counties that have somewhere between five and 82 OB/GYNs.

Weis also said there are only 330 licensed pediatricians – experts in providing care for infants and children – in the state, with most concentrated in metropolitan areas.

More rural providers

Beth Oller, a family medicine physician at Rooks County Health Center in north-central Kansas, initially had little interest in rural medicine — until she completed a medical school rotation in Rooks County. Now, she has served the community for nearly 14 years, she said during the webinar.

Oller said that practicing in a rural and under-served area means you cover many departments, including the emergency room and inpatient care, along with outpatient, hospice and other care. When she started working, the plan was for there to be four physicians helping do deliveries and an additional physician who could do surgical backup for Cesarean sections.

However, everything changed when the other providers either ceased operations or left the area, leaving Oller as the sole provider of obstetric services and raising concerns about the potential closure of the county’s maternity unit.

“I couldn’t do it any more alone,” Oller said. “I knew it wasn’t feasible to keep going that way. I tried everything I could think of … but even in those years when it was two of us, it was extremely difficult.”

Oller said that, luckily, an obstetrics provider now travels from Salina to the facility to help with prenatal care, but it’s still a nearly two-hour drive. She said to encourage people to become providers to rural communities, education about the career opportunities needed to begin earlier — for example, in high school.

“Because often by the time you get someone in medical school, it’s already too late,” Oller said.

“It’s hard to get providers to rural Kansas, and it’s even harder when you realize that a large majority of family doctors who graduate residency don’t plan or have an interest to provide obstetric care,” Oller said.

Some considerations

The report from the KU School of Nursing also suggested ways to improve access to care for pregnant women.

One way is through telehealth – that is, receiving health care services remotely.

Another way is promoting collaboration between health care providers, such as obstetricians and gynecologists partnering with family physicians and other providers to provide consultation and training.

Freestanding birthing centers are struggling to stay open despite high demand due to low Medicaid and private insurance reimbursements. From 2021 to 2023, inflation rose 12.4%, while Medicare inpatient reimbursements grew only 5.2%. The American Hospital Association is encouraging legislation to raise maternity care reimbursements, ease partnership barriers and mandate Medicaid coverage of telemedicine for maternity care, the report said.

The report also said that it’s important for everyone in Kansas to protect the maternity care services that people already have.

“Additional engagement, collaboration and research are critical for making better decisions on behalf of Kansas mothers and babies,” the report said. “With scarce resources, every policy decision has the potential to make lasting and positive change for all Kansans.”