- A report by the Kem C. Gardner Policy Institute highlights Utah's maternal health disparities.
- Racial minorities and rural residents face higher risks due to limited healthcare access.
- 70% of maternal deaths in Utah were preventable according to the report findings.
SALT LAKE CITY — Maternal health in Utah isn't consistent, with outcome gaps for racial and ethnic minorities, women who give birth at later ages and those who live in rural communities.
That's the bottom line in a new report on maternal health risk factors, workforce gaps and access to care released by the Kem C. Gardner Policy Institute at the University of Utah on Tuesday, accompanied by a panel discussion.
The report, produced in collaboration with the Utah Department of Health and Human Services, found 70% of Utah's maternal deaths could have been prevented. Maternal health refers to a woman's health during pregnancy and for a period of time postpartum.
The top three causes of poor outcomes are mental health conditions, substance use disorders and obesity.
The report found many factors, however, that combine to contribute to those poor maternal health outcomes, including both physical and mental health — which has worsened considerably in the last decade — substance use, intimate partner violence, lack of access to maternal health care and social determinants of health like poverty, food insecurity and transportation challenges.
The report said — and the panel agreed — that the share of women experiencing each risk factor for poor maternal health outcomes depends on individual situations, including how far they are from maternal health care services.
In some cases, care is far away in Utah, including five counties where women must travel an hour or more to the nearest birthing hospital. And many women who are far from care are not in a financial position to take time off to travel to doctor appointments that are more readily accessible in urban areas, according to panelist Danielle Pendergrass, a nurse consultant with Eastern Utah Women's Health.
She listed income and geographic location as the two major barriers to receiving adequate prenatal and other maternity care for those in rural Utah. "It's a great day when I only had to take a half-day off work to get to my appointment," Pendergrass said she has been told by women making low wages in her community.
The report also noted that the share of Utah women of reproductive age with physical or mental health challenges has been rising, putting more women at risk of complications.
Even so, Utah fares better than the national average, with 16 cases of maternal mortality per 100,000 live births, compared to 23 per 100,000 nationally. When it comes to severe outcomes short of death, Utah averages 61 per 10,000 compared to 88 nationally.
According to the Utah birth certificate database in the Office of Vital Records and Statistics, there were nearly 45,000 live births in Utah in 2023, with almost 6 in 10 of the mothers residing in Salt Lake or Utah counties. Of those, just under 83% were delivered by a physician, 13% by a certified nurse midwife, not quite 4% by other midwives and 0.3% by "other." More than 95% of those births took place in a hospital. But the report notes that seven Utah counties do not even have a birthing hospital.
Where are the risk factors?
The report found that "rates of pre-pregnancy risk factors (e.g., obesity, diabetes, and hypertension) are higher in Utah's rural counties. Over 19% of 2023 Utah births occurred in counties with a high prevalence of pre-pregnancy physical health risk factors. Sexually transmitted infections are another pre-pregnancy risk factor, with rates highest among Wasatch Front counties and San Juan County."
Poor physical health is a greater issue among Utah women in racial and ethnic minority populations and also for those with household incomes below the federal poverty line, per the report. The highest prevalence is in Piute (30.1%), Wayne (24.3%), Carbon (23.5%), Sevier (22.9%) and Emery (22.6%) counties.
In Utah, the rate of poor mental health rose 18.7 percentage points in 10 years, increasing the risk of pregnancy complications. And mental health challenges are more common among Utah women than the national average. Close to 4 in 10 Utah women of childbearing age have been diagnosed with depression, and 1 in 6 experience symptoms of postpartum depression.
"Data show that only 55% of Utah women with symptoms of anxiety or depression before, during or after pregnancy report asking for help from a health care provider," the report said.
More than 43% of women ages 18-44 — the range considered of reproductive age — living below poverty experience poor mental health, compared to 34.4% living above that federal poverty line, the analysis found.
Substance use not only negatively impacts outcomes for both mother and baby, but also decreases the likelihood a pregnant woman will seek prenatal care.
So does lack of health insurance, which is more likely among women in racial and ethnic minority populations than among white women. Lack of insurance is also more likely in rural counties of the state.
As for intimate partner violence, during pregnancy it is linked to maternal depression, anxiety, PTSD and greater risk of maternal death. It also increases the likelihood of giving birth prematurely, low birth weight and fetal injury, per the report.
"But the bigger barrier is cultural," said Kasey Shakespear, executive director of the Rural Health Association of Utah. "We (in rural communities) don't like to ask for help. We don't like to bother people," he said, noting rural residents put themselves last. As for mental health, he said people are even less likely to seek care for fear of being judged harshly. It's not just access, he said. "You don't want people to know you struggle."
