Utahns face barriers to maternal healthcare – The University of Utah

Report on Maternal Health Disparities in Utah and Alignment with Sustainable Development Goals

Introduction: Addressing Maternal Health in the Context of SDG 3

A new report from the Kem C. Gardner Policy Institute, in collaboration with the Utah Department of Health and Human Services, analyzes significant challenges to maternal health care in Utah. The findings highlight critical gaps that impede progress toward Sustainable Development Goal 3 (Good Health and Well-being), particularly target 3.1, which aims to reduce the global maternal mortality ratio. The report focuses on understanding risk factors, reducing disparities in access to care, and strengthening the health workforce to improve outcomes for women and children.

Key Challenges to Achieving Universal Health Coverage (SDG 3.8) and Gender Equality (SDG 5)

The report identifies three primary areas of concern that represent significant barriers to achieving universal health coverage and ensuring access to reproductive health services as outlined in the SDGs.

• Inadequate Health Workforce: A severe shortage of maternal health care providers undermines the foundation of a resilient health system, directly impacting SDG 3. Melanie Beagley of the Gardner Institute notes that Utah’s maternal health workforce is under-resourced, with projections indicating the gap will widen.
• Geographic and Economic Barriers to Access: Consistent with SDG 10 (Reduced Inequalities), the report finds that long travel distances to care facilities disproportionately affect rural and low-income families. These barriers prevent equitable access to essential health services.
• Gaps in Mental and Preventative Health Care: Insufficient access to maternal mental health treatment and preventative care for women represents a failure to provide comprehensive health services, a core component of SDG 3.

Analysis of Findings: Disparities and Risk Factors Impeding SDG Progress

The report details specific findings that illustrate the scale of the maternal health crisis in Utah and its conflict with multiple Sustainable Development Goals.

1. Maternal Health Workforce Shortages: 22 of Utah’s 29 counties are designated as primary care workforce shortage areas. Over 77% of 2023 births occurred to mothers in these underserved counties, directly challenging the state’s capacity to meet SDG 3.
2. Access to Birthing Hospitals: In five counties (Kane, Wayne, Emery, Daggett, and Rich), the average travel time to a birthing hospital exceeds 60 minutes. This geographic disparity, along with associated costs like transportation and lost wages, exacerbates inequalities, running counter to the principles of SDG 10.
3. Disparities in Maternal Health Outcomes: While Utah’s aggregate maternal health outcomes are better than national estimates, significant inequalities persist. Poor outcomes are higher among racial and ethnic minority populations and women giving birth at later ages, highlighting a critical need to address SDG 10.
4. Contributing Factors to Maternal Deaths: Mental health conditions, substance use disorders, and obesity are leading contributors to maternal deaths. Furthermore, more than one in four women who died during or after pregnancy faced at least one barrier to accessing health care, a direct contravention of the goals for universal access under SDG 3 and SDG 5.
5. Varying Prevalence of Risk Factors: The prevalence of risk factors, including poor physical and mental health, poverty, and access barriers, is higher among women in rural counties and racial and ethnic minority women, reinforcing patterns of systemic inequality targeted by SDG 10.
6. Increasing Rates of Poor Health: The prevalence of poor mental health among Utah women of reproductive age has increased by 18.7 percentage points over 10 years. This trend signals a worsening public health issue that puts more women at risk for pregnancy complications, threatening future progress on SDG 3.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being
   • The entire article focuses on maternal health, which is a central component of SDG 3. It discusses issues like maternal health outcomes, contributing factors to maternal deaths (mental health, substance use), access to healthcare, and the need for a strong health workforce. The article explicitly mentions the goal of ensuring “all Utahns have the opportunity to live safe and healthy lives.”
2. SDG 10: Reduced Inequalities
   • The article highlights significant disparities in maternal health outcomes and access to care. It states that “poor maternal health outcomes are higher among Utah’s racial and ethnic minority populations” and that barriers to care are “especially challenging for low-income and rural Utah families.” This directly connects to the goal of reducing inequalities within a country.
3. SDG 5: Gender Equality
   • Improving maternal health is fundamental to achieving gender equality. The article’s focus on addressing risk factors for poor maternal health, ensuring access to care for women, and strengthening the maternal health workforce supports the broader goal of empowering women and ensuring their health and well-being.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.1: By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
   • The article directly addresses this target by discussing “contributing factors to maternal deaths in Utah” and highlighting that “more than 1 in 4 women who died during pregnancy or postpartum had at least one barrier to accessing health care.”
2. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • This target is relevant as the article identifies “Mental health, substance use disorders, and obesity” as the most common contributing factors to maternal deaths. It also notes that “rates of poor mental health increasing by 18.7 percentage points in 10 years.”
3. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…
   • The article extensively details barriers to achieving universal health coverage for maternal care. It points to “long travel distances, limited provider availability,” and “gaps in access to care.” The mention of challenges like “gas money, reliable vehicles, missed work, lost wages” relates to financial risk protection.
4. Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce…
   • The core issue of a “maternal health workforce shortage” is a central theme. The article states, “Utah’s maternal health workforce is under-resourced,” and “22 of Utah’s 29 counties are designated primary care workforce shortage areas,” directly aligning with the need to strengthen the health workforce.
5. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… race, ethnicity… or other status.
   • The article’s findings that “poor maternal health outcomes are higher among Utah’s racial and ethnic minority populations” and that risk factors are “more prevalent among women living in Utah’s rural counties” point directly to inequalities that this target aims to eliminate.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Maternal Mortality Rate (Indicator 3.1.1)
   • This is implied through the discussion of “contributing factors to maternal deaths” and the statistic that “more than 1 in 4 women who died during pregnancy or postpartum had at least one barrier to accessing health care.”
2. Health Worker Density and Distribution (Indicator 3.c.1)
   • The article provides specific data for this indicator, stating that “22 of Utah’s 29 counties are designated primary care workforce shortage areas” and that “Over 77% of Utah’s 2023 births occurred to mothers residing in these 22 counties.”
3. Service Coverage and Access to Care (Related to Indicator 3.8.1)
   • The article uses travel time as a direct measure of access. It specifies that “In five Utah counties, the average travel time to a birthing hospital is over 60 minutes.” This serves as a tangible indicator of barriers to essential services.
4. Prevalence of Health Risk Factors (Related to Target 3.4)
   • The article provides a specific indicator for mental health, noting that “rates of poor mental health increasing by 18.7 percentage points in 10 years.” It also mentions the prevalence of obesity and substance use disorders as contributing factors to maternal deaths.
5. Health Outcomes by Population Group (Related to Target 10.2)
   • The article provides a qualitative indicator of inequality by stating that “poor maternal health outcomes are higher among Utah’s racial and ethnic minority populations and women giving birth at later ages,” which can be used to measure disparities.

4. SDGs, Targets, and Indicators Table

Source: attheu.utah.edu