Why thousands of women will have to make health care moves in 2024

A ruling by the Alabama Supreme Court last week determined that frozen embryos are children and subject to the same protections of the state as children existing outside the womb, now making the procedure and policy of handling these embryos very complicated and high risk for the fertility centers helping women become pregnant.

With three of the seven facilities pausing operations indefinitely in Alabama, families with embryos are faced with difficult choices. They now have to figure out how to move forward, what the additional expenses will look like and which state will be safe for frozen embryo transfer.

Women in the middle of complicated and expensive IVF treatments in Alabama are now frantically trying to create an exit strategy to keep their fertility journey on track.

This means that for the time being, they too will have to travel out of state to receive the highly specialized services they need to complete IVF. They join the groups of other Alabama women who have to leave to receive high-risk maternal health care services after Alabama began enforcing its total abortion ban in June 2022.

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The Pew Research Center reports that 4 in 10 adults have used fertility assistance to have children or know someone who has. That’s about 42 percent of Americans. As lawmakers continue to create more restrictive laws with heavy penalties around reproductive health, the business of having a baby just became exponentially more complicated and expensive for families.

The decision to start or add to one’s family is becoming an even more difficult, complex kitchen table discussion for your clients. This is an even more critical decision for women of color, as their maternal mortality rates are significantly higher than any other demographic.

Access to quality maternal health care in this country is becoming harder and harder to come by for many women. The state you live in will now determine the types of life-saving measures patients will have access to if their pregnancies have complications or special needs.

Real estate agents need to stay on top of what is happening, as these factors will soon begin to impact personal decisions about where your prospects and clients will decide to lay down roots.

It’s more than considering family values at this point; it’s considering what type of health care you want to have during your pregnancy and, in the case of Alabama, the right to pursue IVF treatments to become pregnant.

Let’s dive into the state of maternal health care in America, why doctors are leaving certain states, how these changes impact real estate and what you need to know about the changing landscape of reproductive health care for 2024.

How maternal health care quality changed in 2023

One year after Roe vs. Wade, we covered the stats of where women’s health care stood across the country and how it reflects many serious issues, including affordable housing.

No matter where your political values land, ensuring women have access to quality health care services is essential. As state legislatures continue to get in the weeds on reproductive rights, they are creating ripple effects for the medical community and the quality of care available to their constituents.

In the graph above, the Commonwealth Fund used 12 new factors surrounding women’s health care to create the overall health care ratings for the state. The appendix the study used indicated several areas they focused on, including infant mortality, maternal mortality, breast and cervical cancer screenings, and the differences in the different types of care services that are offered to those of other races.

This means that women seeking the best health care options for their current and future families and where they choose to live will impact the type of care and the potential outcomes of their pregnancies.

The Cleveland Clinic reports that around 50,000 people in the U.S. experience severe pregnancy complications annually. Black women are about three times more likely to die from pregnancy-related complications than white women.

Fertility is a growing issue in America, according to the Center for Disease Control (CDC), and more women are struggling to have children.

“In the United States, among married women aged 15 to 49 years with no prior births, about 1 in 5 (19%) are unable to get pregnant after one year of trying (infertility). Also, about 1 in 4 (26%) women in this group have difficulty getting pregnant or carrying a pregnancy to term (impaired fecundity),” according to the CDC.

The ripple effect: Doctors are leaving these states

To further compound the problem, many doctors and nurses who specialize in maternal care are leaving states with strict reproductive health care laws. Between the potential legal implications and rising insurance costs, the risks outweigh the rewards of continuing to practice in a state that has strict laws around abortion and reproductive rights.

Last year, ABC News tackled the story of women struggling to access quality health care in a post-Roe America. “On the Brink” was a special that interviewed 18 women impacted by the landscape of available health care services to women in their states.

In interviews with ABC News, physicians in Texas, North Carolina, Ohio and Florida said they decided to leave their states due, at least in part, to the impact abortion bans have had on their ability to practice medicine and provide the best care possible for patients.

New physicians are also not choosing states with restrictive laws to move to, as they want to set up their new practices in states that will foster their success, not land them in potential legal entanglements.

“Researchers from the University of Utah School of Medicine received responses from nearly 350 graduating obstetricians and gynecologists from training sites in 37 states. Findings showed more than 17% of residents said the Dobbs v. Jackson Women’s Health Organization decision changed their practice and fellowship plans,” USA Today reports.

This means that the states with the highest maternal death rates are also driving away the very health care providers that could potentially improve the health care quality for women in their state.

Failing grades for maternal and infant care

In March of 2022, the March of Dimes released a report, “Nowhere to go: Maternity Care Deserts Across the U.S.,” detailing the large-scale lack of maternal care in counties nationwide.

These large spans of spaces without reproductive health care for women are called “maternity care deserts,” and they will continue to grow as we reach the mid-2020s if more states pass restrictive laws around reproductive health care.

So, how is a maternity care desert defined? The report uses the criteria of reviewing “if there were no hospitals providing obstetric care, no birth centers, no OB/GYN and no certified nurse midwives.” Based on that qualifying criteria, the findings of this report show that 36 percent of U.S. counties are considered deserts, and 61 percent (2 in 3) are located in “rural” areas.

The March of Dimes also gives an annual report card to states based on “the collective factors that contribute to maternal and infant mortality and morbidity” since 2008.

In 2023, the overall U.S. got a D+ on this report card, and Alabama — joined by Louisiana, Mississippi, Arkansas, South Carolina and West Virginia — received Fs.

Since 2018, these deserts have grown by almost 4 percent, according to the report.

Housing and maternal and infant health are deeply connected

Access to quality health care and affordable housing are two critical factors for a thriving local community. Studies have shown for years that having a safe place to live close to quality health care impacts positive outcomes for everyone in that community.