In Hawaii, we’re used to patting ourselves on the back for our statistically healthy lifestyles and lengthy lifespans. But by one crucial measure of health — prenatal care — the state is faltering.
Too many women in Hawaii are not accessing prenatal care, sinking Hawaii to the lowest ranking in the nation for “adequate” health care of this type — defined as health care begun within the first four months of pregnancy and continued throughout a pregnancy.
Only 62% of expectant mothers in Hawaii received adequate prenatal care in 2021, according to government data, while the national rate is about 75%.
Prenatal care is crucial for mothers and babies, but it’s also important for communities. Inadequate or missing prenatal care leads to increased rates of cesarean sections and other complications of birth. Low birth weight and other complications may lead to disabilities that hurt and stress families and communities, with an extended, costly need for services.
The state should strive for the best outcomes for expectant mothers and newborn infants, for the sake of Hawaii’s families.
The causes for our dismal ranking are several, and go beyond the number of doctors. On Oahu, there is no official shortage of doctors qualified to provide prenatal care, but Oahu shares the worst rate of attainment with Hawaii island: On both, just 60% of women received adequate care, on average, in the years 2019-2021.
On Maui, the reported availability of prenatal care is 80% — but the only private obstetrics-gynecology practice on the island is preparing to shut down childbirth services. (Kauai provided the best access, with 86% of women receiving adequate care.)
Statewide, about 1 in 9 infants in Hawaii is born to a mother who received no pregnancy care until the third trimester — or worse, received no prenatal care at all. That rate is about twice the national average. Worse, since 2001, when 82% of women began prenatal care in their first trimester, the rate had declined to 71% by 2021.
Solutions to the problem can come from a variety of sources. On Oahu, and on Hawaii island, many doctors do not accept Medicaid, and so are not available to low-income women. Gov. Josh Green and the Legislature approved this year an increase in Medicaid reimbursement rates that should provide at least some improvement in availability.
Hawaii’s recent initiative to ease requirements for out-of-state doctors and other health care professionals to practice in the islands can also be a valuable tool. Here, and with training priorities at the John A. Burns School of Medicine, the state should incentivize doctors who provide prenatal and childbirth services in areas of need.
On Maui, where the island’s only private obstetrics practice will stop delivering babies in October, the island’s federally funded clinic, Malama I Ke Ola Health Center has seen its prenatal patients nearly double. The clinic is seeking funding to recruit doctors, and both state and federal dollars would be well-spent in meeting this need.
More resources also must be allocated to outreach and education for women at risk, as a disturbing increase in Hawaii’s congenital syphilis cases indicates. Between 2000 and 2019, four or fewer cases of congenital syphilis were reported annually; this tripled to 12 cases reported in 2020, then 20 cases in 2021. Here, many cases occur among homeless women and drug users. The state Department of Health is working to increase outreach and treatment with mobile health units — and this approach could also be used to reach women who have difficulty visiting a doctor or clinic for other reasons, such as lacking child care or transportation. Early detection and treatment are the key.
Hawaii must support all of the above, as well as new approaches to reverse the unhealthy trends that have developed. To reverse the state’s ranking from last to first in the nation for prenatal care should be a top priority.
