"I wish I could say I was surprised," said Jacqueline Blocker, executive director of Tulsa-based Metriarch, a women's public health data and policy nonprofit organization. Oklahoma is tied with Nevada for 48th, ahead of Texas and Mississippi, in the Commonwealth Fund rankings, which scored the 50 states and the District of Columbia on each of more than 30 measures of women's health care. Oklahoma was 50th for maternity care workforce — doctors and nurse midwives practicing in obstetrics and gynecology per 100,000 women and girls ages 15 to 44.
It was 47th for outcomes; 45th for coverage, access and affordability; and 47th for quality and prevention. There were some bright — or at least less-dim — spots. Oklahoma ranks in the middle for low-risk cesarean births, which means women are not being subjected to unnecessary and potentially dangerous surgery.
The state ranks 20th for women older than 65 who have received a pneumonia vaccination. And observers are eager to see whether recent expansions in Medicaid coverage, especially for pregnant women and new mothers, will improve outcomes. But there is also this: Blocker said a recent survey found that 70% of Oklahoma's licensed OB-GYNs plan to leave the state, have already left or want to leave.
The reasons are unclear but seem to involve a combination of factors, including relatively high rates of uninsured women, administrative headaches, working conditions and Oklahoma's restrictive abortion laws. "To be frank, if doctors don't believe they can fully practice their profession the way they've been trained, they look somewhere else," Blocker said. For the most part, this does not seem to be a matter of professionals wanting to specialize in abortions.
It is about being able to exercise judgment concerning patients whose lives may be in danger. Those who support Oklahoma's abortion laws argue that this is not really a problem, but the Commonwealth Fund says its study shows a nationwide trend toward less access to OB-GYNs and related professionals in states with more restrictive abortion laws. "What we've found is most of the states that have bans tend to have the lowest number of people working in maternity care per 100,000 women," said Sara Collins, one of the Commonwealth Fund study's authors.
Worth noting is that the data for this portion of study is from before the U.S. Supreme Court overturned women's right to abortion, meaning the study does not capture changes in state laws — including Oklahoma's — since then.
"This is something we'll be tracking over time," Collins said. Listen now and subscribe: Apple Podcasts | Google Podcasts | Spotify | RSS Feed | SoundStack | All Of Our Podcasts All of that said, no one said abortion laws are the only or even biggest reason for Oklahoma's low rankings for women's health. Mary Gowin, who as an associate professor of family and preventive medicine in the College of Medicine at the University of Oklahoma Health Sciences Center specializes in primary health care policy and workforce development, says the shortage of women's health professionals is part of a more general shortage.
That shortage is more acute, and in some cases connected to, Oklahoma's relatively large rural population. "About 60% of the counties in Oklahoma do not even have an OB-GYN practicing in them," Gowin said. "One of the solutions I hear a lot is, 'Well, but, but they don't have to get care from an OB-GYN, right? They can go to a family practice doc or a nurse practitioner .
.. or a (physician's assistant).
' "And that is actually a very reasonable expectation," she continued. "But we also have primary care shortages in the state, as well as geographical challenges. There are counties in Oklahoma that have no health care provider, and so if we don't have a sufficient network to take care of our population, it's very difficult to have basic preventive visits, because our physicians and our advanced practice providers are booked way out.
" For many women, the combination of distance and time is a difficult or impossible obstacle to care, especially for what many consider routine things such as pre-natal checkups, mammograms and screening for cervical cancer. "We have about 11,000 patients to every one OB-GYN practicing in our state," Gowin said. "And there are a lot of people that think that number is actually underestimated.
A lot of OB-GYNs are not taking new patients because they have a full patient (load) already." Gowin and others say one reason for the shortage of medical professionals, including OB-GYNs, is that Oklahoma does not have enough residencies to train all of its medical school graduates. Studies show that doctors ultimately tend to practice near where they complete their residencies.
The Oklahoma residencies that are available are mostly in the Oklahoma City and Tulsa metro areas. Ideally, said Gowin, "we wouldn't just have them doing residency at academic medical centers or in major metropolitan centers, but we would actually have residency positions in tribal, rural and medically underserved areas so that they can actually learn to practice and discover the joy of practicing in those types of areas." Some of that is happening, most notable in northeastern Oklahoma through the Oklahoma State University Center for Health Sciences' collaboration with the Cherokee Nation .
Overall, though, rural hospitals' struggles seem to grow, and Blocker said overconfidence in the health care system has been shaken by COVID-19 and other factors. "If a hospital disappears, people don't understand the details," she said. "They just know it's gone.
" Oklahoma's ratings for women's health care Among the 50 states and the District of Columbia, Oklahoma ranks: Overall: 48 (tie) Maternity care workforce: 50 Lack of care because of cost: 48 Uninsured women: 49 Quality and prevention: 47 Source: The Commonwealth Fund The Tulsa World is where your story lives.
