At the height of the Great Depression, Windham Community Memorial Hospital was built in northeastern Connecticut with generous donations from ordinary local residents. A month after newly elected President Franklin Delano Roosevelt gave his Inaugural Address declaring that “the only thing we have to fear is fear itself,” the hospital opened its doors. On April 25, 1933, the first baby was delivered there.

Eighty-seven years later—at the height of the Covid pandemic—the hospital shut down its labor and delivery ward. The story of how Windham Hospital stopped delivering babies is emblematic of a nationwide crisis in rural maternity care. The US health-care system is under tremendous financial and political pressure to become more cost-effective. In obstetrics, this often means a preference for consolidating deliveries at urban hospitals with sophisticated technology and a large medical staff. This consolidation comes at the expense of women in rural areas.

Windham County is one of Connecticut’s most economically depressed regions. The region’s manufacturing base, once home to a thriving textile industry, has been hollowed out. In 1985, one of the county’s largest employers, the American Thread Company, shut its factory doors.  Willimantic (part of the town of Windham), the home of the American Thread Company’s sprawling factory, went from being known as “Thread City” to “Heroin Town” at the turn of the 21st century. The region’s heroin problem has improved, but its economic troubles persist.

The county’s recent political evolution tracks with other regions nationwide that have suffered economic decline. For years, the county had reliably voted for Democrats, but went for Donald Trump by eight points in the 2016 presidential election. In 2020, the county again swung for Trump, by a margin of 52 percent to Biden’s 48 percent. According to the US Census, the county is majority white but home to a significant Latino population.

The shuttering of the Windham maternity unit was only the latest indication of an ongoing loss of local health services. This process began when Windham Hospital was bought by the conglomerate Hartford HealthCare. After the acquisition, Windham’s intensive care unit was closed down in 2015, and critically ill patients were diverted to hospitals in more urban areas.

All of this mirrored similar trends playing out across the state and the nation. In the past 20 years, Connecticut has gone from having nearly two-dozen independent hospitals to only a handful. Most Connecticut hospitals are now part of large chains. Lynne Ide, who works at the Universal Health Care Foundation of Connecticut, told me that as a result of this consolidation, the large hospital systems “cherry-pick” which services to provide where. This particularly affects rural health care, as the large systems “consolidate care into whatever place they decide they want to consolidate it.”

Before the labor and delivery ward closed, almost all of the women it served were insured by Medicaid. The hospital reported that in 2019, 82 percent of its labor and delivery payments were from Medicaid; 10 percent of patients were uninsured, and 8 percent had private insurance. This so-called payer mix matters because Medicaid coughs up significantly less for hospital births than commercial insurance. Windham Hospital estimated it would save $2.5 million annually by closing its inpatient obstetrics service and sending laboring women to other local hospitals.

The hospital has also struggled to find staffing for its maternity services. In public filings, Windham explained that in 2015, a local OB-GYN group stopped delivering at the hospital. After that, the number of births at the hospital dropped significantly, to 58 when the maternity ward closed in 2020, down from 376 in 2014. The loss of patients can have a cascading impact on a labor and delivery ward’s ability to operate safely. If providers don’t keep their skills sharp by delivering babies, it becomes riskier for women to deliver there. During public argument, an attorney for the hospital explained: “The reality is Windham cannot safely operate its OB service due to a lack of available obstetricians and other clinical staff.”

Connecticut is a small state, and at least compared to more remote regions of the United States, the closure of Windham’s maternity unit didn’t massively increase travel time to the hospital for women in labor. Lisa Thomas, a local elected leader and activist in the area who has opposed the closure of the unit, told me that the next closest hospital is likely a 25- to 30-minute drive from Windham. Still, according to Thomas, many of the routes involve rural roads prone to weather problems, accidents, and slow-moving farm equipment. For Windham’s poorest residents, the increased travel time is particularly burdensome, as it involves seeking care away from supportive family and friends who may lack transportation. Plus, for women in labor, any additional travel time can make a significant difference. (While Windham’s emergency room can still assist laboring women in emergencies, pregnant mothers are usually sent elsewhere.)

The Covid pandemic appears to have been the tipping point for the closure of Windham’s labor and delivery unit. Connecticut saw three other maternity-ward closures or attempted closures during 2020 and 2021. Saint Raphael’s in New Haven and Johnson Memorial Hospital in Stafford Springs also stopped offering these OB services, and a third hospital in Sharon sought to close its maternity unit. An association of Connecticut hospitals reported in March 2023 that the pandemic had caused $164 million in losses the prior year.

Recognizing Covid disruptions, Connecticut’s governor issued an emergency order during the pandemic allowing hospitals to temporarily stop services without state approval. Windham, however, sought to permanently close its labor and delivery unit. The hospital didn’t initially seek state authorization for the closure, but instead simply ceased to provide services and sought the state’s permission weeks later.

The state government then leveled a fine against the hospital for failing to seek authorization. Windham contested the penalty. During the resulting hearing, a government lawyer alleged that Windham “broke the law” by not obtaining authorization “before terminating these essential medical OB services.” She also alleged that “the consequences for breaking this law are being widely felt throughout the Windham community, a community that can no longer rely on the security of having a local hospital ready when they are to deliver a baby.” No final decision has been reached on the civil penalty.

In a separate hearing, Windham Hospital was denied state authorization to close its labor and delivery unit. The hearing officer found that the closure would, among other things, impede access. The decision is on appeal. In the meantime, the unit remains closed, and laboring women are being sent to other area hospitals.

“Economies of scale support expanding geriatric care while reducing maternity care.”

In neighboring Tolland County, Johnson Memorial Hospital is also facing pushback for closing its maternity ward. That hospital has, however, just opened up a new geriatric wellness center. In a news release, the hospital said, “With a significant increase in the number of older adults anticipated in our service area in the coming years, the need for this new unit is undeniable.”

In other words, economies of scale support expanding geriatric care while reducing maternity care. Absent state action, the future of Connecticut’s health system, it appears, lies not in birthing babies, but caring for the elderly. This is a grim harbinger for both the state and the nation.

Ivana D. Greco is a fellow at the Abigail Adams Institute in Cambridge, Mass.


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