Senate Joint Resolution 331 from the 1995 General Assembly directed the Joint Commission on Health Care to study access to obstetrical care for the women of rural Virginia. This report presents the findings of the study along with policy options for improving access to obstetrical care in rural areas.

Quality obstetrical care is obviously important for good maternal and infant health. Early prenatal care can help to reduce infant mortality and low-weight births. Specialty obstetrical care is critical for high-risk pregnancies and difficult births. However, the availability of medical care, by itself, is not enough to assure good maternal and infant health. Experience shows that providers and local communities must work together to provide outreach, education, counseling, transportation, and other services to make sure that women receive the right services at the appropriate time.

Conventional measures such as infant mortality rates and low weight births indicate that although Virginia has made significant progress, there is more work to be done to improve maternal and infant health status in the Commonwealth. While the infant mortality rate is declining, it is still unacceptably high, particularly for minority infants. At the same time, the rate of low-weight births is rising, causing both human suffering and economic stress within the health care system. These are statewide problems which are particularly acute in rural areas of Eastern, Southside, and Southwestern Virginia.

There are several barriers to obstetrical care in rural areas which must be addressed if Virginia is to make continued progress toward improved maternal and infant health. Many pregnant women still lack health coverage and thus the ability to par for needed health care services. At the same time, the supply of obstetrical providers - including obstetricians, family physicians, and nurse midwives - is dwindling in rural areas, at least partly due to economic disincentives and a lack of adequate collaboration between different provider groups. These issues, combined with educational and social problems, result in complex challenges which defy simple solutions.

This report includes five policy options for improving access to obstetrical care in rural areas:

* To improve access to health coverage for pregnant women and infants, the General Assembly could consider expanding eligibility for the Virginia Medicaid program as one option for removing financial barriers to obstetrical care.

* To contain malpractice insurance costs for rural obstetrical providers, the General Assembly could consider requesting the Secretary of Health and Human Resources, the Bureau of Insurance, and the Worker's Compensation Commission to conduct a study of the effectiveness of the Virginia Birth-Related Neurological Injury Compensation (VBRNIC) Program in rural areas.

* To improve collaboration among obstetrical care providers: (i) the Virginia Academy of Family Practice and the Virginia Obstetrical and Gynecological Society could form a joint task force for the purpose of developing guidelines for effective collaboration: (ii) Virginia's academic health centers could evaluate their programs for obstetrical training of family practice residents to ensure that their graduates are fully prepared to meet the demands of rural obstetrical practice within a collaborative environment with obstetricians; and (iii) the General Assembly could consider funding a nurse midwifery training program at Virginia Commonwealth University-Medical College of Virginia.

Public comments on this report were received from fifteen individuals and organizations. These comments, which are summarized in the back of the report, provide thoughtful insights on the issues and options raised in the report.

/s/ Jane N. Kusiak
Executive Director