Wyoming’s first-ever maternal health summit drew more than 150 caregivers, public officials and advocates from across the Mountain West to discuss solutions to fill gaps in rural healthcare.
About half of the counties in the state, where towns can be separated by dozens of miles, don't have an OB-GYN, according to a 2024 state health department report. Additionally, at least nine counties don’t have basic labor and delivery units. Several have closed in recent years due to the high costs that come with a low number of patients.
The Laramie summit on Sept. 2 and 3 could signal a turning point in the state’s ability to respond to the complex maternal care issues, said lead organizer Gaby Alvarado.
“People learned about [the summit] three days in advance and dropped everything to join us. It feels like a priority,” said Alvarado, a women’s health researcher.
Alvarado has worked with rural communities in Costa Rica, where she’s from, and in Alaska. She’s a new addition to the University of Wyoming’s Rural Health Institute, which funded the summit with a federal Maternal Health Innovation Program grant.
The $5.2 million in federal dollars could go toward more than summits. They could also fund potential solutions, such as an online resource hub with information about virtual and local healthcare options or support systems for birthing.
The goal is to “bridge that gap so that lack of information doesn't mean lack of access,” Alvarado said.
Summit attendees also discussed investing in the people who support birthing, like nurses who visit homes, community health workers and doulas.
Learn more about what’s next in Wyoming Public Radio’s interview with Alvarado below.
Editor's Note: This interview has been edited for clarity and brevity.
Hanna Merzbach: You were the driving force behind Wyoming's first Maternal Health Summit. Why do you think this summit was so necessary?
Gaby Alvarado: I've been in my position for a relatively short time, and I am just trying to soak up and learn from everyone around me. And throughout these conversations, we kept hearing about kind of disjointed efforts. Like someone didn't know about something going on in the other side of the state. We also found that efforts were kind of fragmented or siloed by discipline. All the doctors come together in an annual meeting, or the social workers and mental health providers and counselors have another separate meeting. We found that it would be really beneficial to bring all the voices into the room.
HM: For our listeners who aren't familiar, could you frame the various maternal care issues in Wyoming for us?
GA: Where to start, right? A lot of them stem from how widespread the population is in Wyoming. And so a lot of those issues stem from varying levels of access to care. And access, the first thing that springs to mind is: “is there something close by, like something within a certain mile radius that I can travel to?” But there's all these other things that also imply access, like, “do you have a car? Is there public transportation in the area that you live so that you can travel these distances?” Maybe it's not super safe at that moment in the year to drive 60 miles in the wind. And because of the low volumes, that kind of contributes to not being able to sustain, financially, some of these services.
HM: I attended the recent summit, and I liked how actionable it was. The first day was all about talking about the issues and potential solutions. The second day was about coming up with action plans. What are some of the solutions you saw people coalescing around?
GA: I think the main big thing is: we need to figure out a way to have some sort of central repository from all of these resources that are available to moms and babies and families. We don't have to reinvent the wheel. A lot of the things that we need are available. We're hoping that this type of central repository for resources can help bridge that gap so that lack of information doesn't mean lack of access.
HM: What else were you hearing from people?
GA: We were hearing also a lot about support for birthing people, be it through home visitation programs delivered by nurses, community health workers or support for people who are pregnant or in the postpartum period through doula care. A lot of these things are a little bit out of reach for people because of the way that we have reimbursement structures through Medicaid. Doula access right now in Wyoming is available to folks who can pay for it out of pocket. Unfortunately, we know a large majority of the births in Wyoming are covered under Medicaid, and so it means those people do not have access to doula care, which is a very well-demonstrated intervention to improve birth outcomes. So there was a lot of conversation about how do we provide sufficient data and information to our policymakers to make smart policy around maternal care?
HM: Some of the other ideas I heard included having more pregnancy tests in public places, having more temporary housing near hospitals for people who need to travel, and finding ways to train Wyomingites who already live here to be doulas, midwives and emergency medical service providers. Where are all these ideas going?
GA: We did a series of strategic planning right after the summit, and we were starting to notice that we were missing certain voices in the room. So, we started inviting additional stakeholders to join us. We extended it to include doulas, midwives, mental health counselors and an obstetrics representative from the tribal reservation. Our initial plan is to create a coalition under the banner of Momentum Wyoming, which is the new maternal health initiative that we launched through the Rural Health Institute. From that coalition, we nominate and elect the central task force. Then this coalition and task force can listen to all of the suggestions, like the ones that you just listed. We think about “what can we reasonably do first, right? Okay, what's like a short-term plan, a medium-term plan, a long-term plan?”
The resource hub felt like an actionable first step, and then there's longer things that we need to plan a little bit more into the future, both through the current grant that we have, but also thinking about, “what are we going to do when this stream of funding ends, and how are we going to sustain maternal health efforts in the state and support our role at the Rural Health Institute as a convener and organizer of bringing people together?”
HM: Wyoming also got over $205 million in federal Rural Health Transformation Program funds to spend in the next year. We could know which awardees have been selected by the end of the month. How could these dollars help fill maternal care gaps?
GA: In the requests for proposals from the state, some of them included funding and support for community health workers, doulas and expanding the workforce in that sense. There's also a lot of funding going into specifically ramping up that pipeline of homegrown providers, physicians and nurses. That is fantastic, but that's a long-term plan, right? That's a several-year turnaround, but it's a really good investment for us to do right now. I believe there's also a little bit of additional money [up to $11 million] that hasn't been specifically allocated yet, but there is an intention to devote that to obstetric services.
HM: Wyoming has spent a lot of time talking about and studying solutions for these maternal care issues but not as much time taking action. What gives you hope that the tides could be turning?
GA: I think that seeing all the people that came together at the summit was really inspiring, and I think that's what makes me hopeful about things turning a corner a little bit. This is the first time we've ever done this summit. We came up with it pretty late in the game, and we only started advertising for it, I think, five weeks in advance, and we had over 150 people in attendance. People like yourself learned about it three days in advance and dropped everything to join us. It feels like a priority. People are letting their legislators know, and I feel like that — not to overuse the word — momentum is what's going to make a difference.
This story was produced by the Mountain West News Bureau, a collaboration between Boise State Public Radio, Wyoming Public Media, Nevada Public Radio, KUNR in Nevada, KUNC in Northern Colorado, KANW in New Mexico, Colorado Public Radio and KJZZ in Arizona as well as NPR, with support from affiliate newsrooms across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting and Eric and Wendy Schmidt.
