By Katie Klingsporn, WyoFile
A new study finds that Wyoming ranks in the bottom 10 states when it comes to women’s access to reproductive health care.
The 2024 Women’s Health and Reproductive Health State Scorecard, which evaluates each state’s health care system based on criteria such as maternal mortality, prevention and access to health care providers, ranked Wyoming 42nd — lower than all of its neighboring states.
Wyoming received particularly low scores in the areas of health insurance, access to care and affordability, coming in at 47th place. In quality and prevention of health care, the state ranked 43rd, and in health and reproductive health outcomes, Wyoming ranked 28th.
The report was compiled by the Commonwealth Fund, a 106-year-old private foundation dedicated to promoting high-performing health systems that improve access, improve quality and increase efficiency.
Wyoming’s ranking isn’t surprising, given that 11 of the state’s 23 counties don’t have an obstetrician-gynecologist and three birthing facilities have closed since 2018, according to the Wyoming Department of Health. There are just 16 active midwives in Wyoming who are licensed by the state Board of Midwives. In Fremont County, which has seen a significant decline in access to obstetric care over the past five years, the average number of births per month at Landers SageWest Hospital has fallen from about 35 to fewer than 20, health department figures show.
The situation has caught the attention of lawmakers and stakeholders. A legislative committee is currently looking at the various factors that lead to a shortage of obstetric care providers and ways to bolster access. A subcommittee of Gov. Mark Gordon’s Health Task Force has also been meeting on the topic for several months. Many ideas have been floated, but no firm plan has yet emerged.
“We’ve been talking about this for a while and we’ve been looking at different things, so I wasn’t surprised at all by some of the scores,” said Jen Davis, Gordon’s director of health and human services policy. “I think it’s really beneficial to continue having those conversations.”
She says the group’s research shows how complex maternity care issues are, and how important it is to consider all factors when looking for solutions.
Serious, complex
A 2023 WyoFile investigation found that Wyoming’s maternity care system is deeply flawed, forcing families to increasingly travel out of the county or even out of state to give birth, posing risks to mothers and babies and often increasing costs.
Stakeholders also point out that these care disparities pose economic threats as young people are reluctant to move and raise their families in states that lack quality prenatal and antenatal care.
Solutions have been difficult to find. Complicating the problem are provider challenges, including low birth volumes in rural areas, the high cost of malpractice insurance, hospitals’ financial viability challenges, the impact of abortion laws on doctors, liability issues, and barriers to midwives delivering in hospitals.
The Joint Labor Committee has made Wyoming’s maternity care shortage, along with child care issues, its interim top priority, meaning committee members are looking at the issue before the next session with the aim of drafting legislation.
At the same time, the Obstetrics Subcommittee of the Governor’s Health Task Force is meeting regularly to consider solutions Wyoming can adopt to enhance access to the critical service of obstetric care.
“Unfortunately, in Wyoming, like rural health care in general, this is a very complicated issue,” Davis told the Labor Committee in June. After digging into the complex issues, he said, the subcommittee identified three main areas of concern: how to better utilize midwives, doulas and family physicians alongside obstetricians in maternity care, the possibility of creating an obstetric fellowship to enhance care in Wyoming, and regionalizing obstetric care in the state.
“This is definitely solvable, but we need to have meaningful conversations with each other about how we meet the needs of Wyoming residents,” Davis said. “I think we need to be really intentional as we do this, because if we do one thing, it will have an impact. [other factors].”
Davis told Wyofile she is confident the governor’s task force and the legislative committee of lawmakers, physicians, obstetrician-gynecologists, midwives and medical professionals will be able to identify initiatives to improve Wyoming’s maternity care environment.
In the Labor Committee’s two previous interim meetings, members have discussed a range of solutions, from tort reform to creating midwifery training opportunities at community colleges.
Sen. Fred Baldwin (R-Kemmerer), a member of the Labor Committee and a physician assistant, attends the subcommittee meetings and noted during the June meeting that the problem doesn’t necessarily come down to a physician shortage.
“You can’t just put providers in places when there aren’t enough patients,” Baldwin said.
“There’s a lot of nuance to this, and it’s not just a matter of getting enough providers,” he continued. “Regionalization is one concept that we should look at, and I think it’s an important concept that we should look at.”
Policy impacts
Declining access to maternity care is not unique to Wyoming: Over the past decade, more than 200 rural hospitals across the country have stopped providing birth services, a trend that prompted the national scorecard, according to the Commonwealth Fund report.
“Clearly, women’s health is under threat,” the report states, “which is why the Commonwealth Fund developed the first-ever State Scorecard to track women’s health trends over time and document how policy choices and judicial decisions affect women’s access to timely health care.”
The report cited state policies that affect this issue, noting that 10 states have yet to expand Medicaid eligibility, while 21 states have tightened or imposed new restrictions or bans on abortion.
Wyoming has not expanded eligibility for Medicaid. The state also passed a ban on abortion since the U.S. Supreme Court overturned Roe v. Wade, but the ban is currently pending litigation, so abortion remains legal.
The Joint Labor Committee is scheduled to revisit the issue at its meeting in Cheyenne on Aug. 29-30.
This article was originally published by WyoFile and is republished here with permission. WyoFile is an independent, nonprofit news organization focused on people, places and policies in Wyoming.
