Maternal care ‘deserts’

State government leaders wanted to transfer that take to Pennsylvania. Now, with Pennsylvania generating more gambling tax revenue than any other state, lawmakers here once again should take a cue from New Jersey, secure in the knowledge that it will not upset the competitive landscape.

Like their Pennsylvania counterparts, New Jersey lawmakers rolled over for casinos over the past few decades while wisely imposing smoking bans on every other kind of indoor activity, and many outdoor activities. The rule now, generally, is smoke if you must but keep it to yourself. The smoking bans have had major positive impacts on public health, including reduction in cancer incidence and mortality.

New Jersey casino workers have had enough of being exposed to deadly secondhand smoke. They have pressured state lawmakers to move a bill banning smoking in casinos. The organization the workers formed to drive the reform, Casino Employees Against Smoking Effects, has several chapters in Pennsylvania.

New Jersey and Pennsylvania suspended all smoking-ban exceptions amid the pandemic but then reinstated exceptions for casinos. In Pennsylvania, some casinos have maintained the bans, recognizing that smoking no longer is necessary to generate profit. Smoking might keep away more potential customers than it attracts, given that the adult smoking rate has declined to about 11%.

Secondhand smoke is complicit in an array of deadly diseases. According to the Centers for Disease Control and Prevention, it still causes more than 33,000 deaths a year due to heart disease and another 7,000 due to cancer.

State lawmakers no longer can justify trading workers’ health for money. They should follow New Jersey’s lead in banning smoking at casinos or, better yet, take the lead.

Pennsylvania has a problem with “maternal care deserts,” places where women of childbearing age do not have nearby access to obstetric care, birth centers, certified midwives or OB/GYNs. According to a report released in October by the March of Dimes, six counties in Pennsylvania are classified as a maternal care desert: Greene, Cameron, Forest, Sullivan, Wyoming and Juniata.

Greene County was ranked as a maternal care desert in part because women have to journey to either another county or to West Virginia to get to a birthing center.

All told, across Pennsylvania, 105,000 women between the ages of 18 and 44 live in communities that have a paucity of obstetric care or none at all. Across the United States, that number reaches

6.9 million, with the largest concentration of maternal care deserts in the center of country, stretching from the Dakotas to Texas. According to the March of Dimes report, there’s been a 2% increase in locations classified as maternal care deserts since 2020.

This is part of the reason the United States has the highest maternal mortality rate among industrialized nations.

Part of the problem comes down to dollars and cents. Rural hospitals have closed as populations have declined, and some of the hospitals that have kept their doors open have dropped maternity care due to low patient volumes. Some communities have struggled to draw qualified medical personnel.

Some experts have suggested telehealth can help fill the gaps, but some of the communities lacking maternal care also don’t have adequate broadband. They also say Medicaid needs to be expanded and more midwives and doulas need to be available in communities off the beaten track.

The gridlock in Washington makes it unlikely any meaningful changes in federal policy are in the offing. In the absence of federal action, state and local officials should do what they can to make giving birth safer and healthier in their communities.