By Senator Catherine Cortez Masto

America is the only developed country in the world where maternal mortality has increased in recent decades. Almost two American women die each day from pregnancy-related complications, according to the CDC, and more than 50,000 every year suffer life-threatening complications like heavy bleeding or heart attacks. But the maternal health crisis facing our nation disproportionately impacts women in rural areas.

Disturbing statistics illuminate just how hard accessing essential health care services can be for pregnant women in rural communities. Less than half of rural women live within a 30-minute drive of a hospital offering perinatal services. Just 6 percent of the nation’s OB-GYN’s live in rural areas, despite the fact that 15 percent of the population resides in remote communities. That trend rings true in Nevada, where more than two-thirds of rural counties entirely lack obstetric services. And though it has improved drastically under the Affordable Care Act, the uninsured rate remains higher in rural areas, compounding the struggle new mothers face when trying to access quality maternal care. In fact, rural mothers are far less likely to obtain prenatal care during the first trimester, limiting their ability to reduce the risk of pregnancy complications and learn about steps for a healthy pregnancy. Broader women’s health is also invariably impacted, with fewer rural women receiving recommended services like cervical cancer screenings and mammograms. The consequences of these limited maternal services are severe. The heart-breaking reality is that the maternal mortality rate is 38 percent higher in rural areas than in metropolitan areas, and the infant mortality rate exceeds the national average in 51 percent of non-metropolitan counties.

Nevada’s women and babies deserve better. This administration’s repeated attacks on family planning programs, cuts to Medicaid and rollback of maternal health benefits under the ACA threaten to only intensify the health crisis. Expectant parents have plenty to think about without the added worry of whether they can make the three-hour drive to the nearest doctor or afford high out-of-pocket costs for basic prenatal and postpartum care. That’s why I’m using my voice in the Senate to stop these policies and stand up for rural families in Nevada, and across the country.

I’m fighting at every turn to protect the ACA, which guarantees maternity care and prevents women from being charged more for insurance simply because they’re women. Pregnancy should never be viewed as a pre-existing condition to charge women higher health premiums. The ACA offers critical health benefits like free birth control, cervical cancer screenings and yearly wellness exams. These are services that women in every zip code across Nevada deserve. That’s why I’ve joined resolutions to fight legal challenges to the ACA, and I’ve challenged this administration’s attempts to gut ACA funding. I’ve also supported the No Junk Plans Act to eliminate inferior health plans that don’t offer robust protections for maternal care enshrined in the ACA. And I’ll continue to support any legislation that strengthens the quality of care and provides greater access to maternal health care, like the Healthy Mom Act that expands health care coverage for pregnant mothers and women with postpartum depression. Under this bill, women can change their health care plan when they become pregnant and retain a guaranteed 12-months of continuous Medicaid eligibility after giving birth. Additionally, I recently joined forces with Senator Jacky Rosen to reverse the Trump administration’s decision to bar nurses from providing family planning counseling under Title X – a decision that places significant strain on rural health clinics that may only have doctors and physician assistants on site once a month to counsel women on pregnancy options.

I’m also fighting to protect Nevada’s Medicaid expansion, which is key to expanding insurance to vulnerable pregnant women and has helped rural hospitals and community health centers keep their doors open. Pregnant women enrolled in Medicaid can start prenatal care earlier than uninsured women, and they can receive care for problems like depression and hypertension following childbirth. Research shows maternal and infant mortality rates plunged in states that expanded Medicaid, and I’m so proud that Nevada chose to extend health care to another 200,000 Nevadans through the Medicaid expansion. The uninsured rate in rural communities in Nevada fell by 14 percent between 2015 and 2016, expanding access to critical services for rural women. This has helped shore up rural hospitals that previously delivered uncompensated charity care to low-income patients, like expectant mothers, who would previously have only obtained care through emergency rooms visits. Uncompensated care costs that harmed the operations of rural hospitals have decreased by almost 49 percent statewide. That’s why when the Administration proposed a budget that would result in $130 billion in cuts to Medicaid over the next decade, I fought to preserve current funding levels. I’m also supporting the incredible work spearheaded by the majority-women legislature in Nevada, which recently passed legislation to establish a board to review maternal mortality issues. In states like California, maternal mortality review committees have resulted in a 55 percent decline in maternal mortality rates, and I’m hopeful similar results can take root in Nevada.

Women across rural America deserve access to quality, affordable care for themselves and their babies. Zip codes shouldn’t determine quality of care. We must work in bipartisan ways to strengthen the ACA and Medicaid and pass legislation that improves maternal health, especially for vulnerable women in rural areas. We must stop putting women and babies in life-threatening situations. I’m fighting every day to protect the Affordable Care Act and put an end to the maternal health crisis.