Access to obstetric care is a critical determinant of maternal and infant health. However, a new study led by the University of Minnesota School of Public Health (SPH) finds that hospital-based obstetric care has declined in recent years, with variability across states. The new analysis, which examined the status of obstetric services in all 4,964 short-term, acute-care hospitals in all 50 states and the District of Columbia between 2010 and 2022. The researchers found widespread losses in hospital-based obstetric services and variability across states — with disproportionate impacts in rural communities.

Using an enhanced algorithm developed by SPH researchers, the team identified and validated whether hospitals stopped providing obstetric services, either because they closed entirely or shut down their obstetric units, over the 12-year period. Hospitals were distinguished by whether they were located in urban or rural counties. The researchers also highlighted states that were highly rural — those in which more than 30% of the state’s population lived in a rural county.

The study, published in Health Affairs, found:

• Widespread loss of obstetric services across states, especially among rural hospitals. Between 2010 and 2022, seven states saw at least 25% of all hospitals close their obstetric units. By 2022, eight states had more than two-thirds of rural hospitals without obstetric services.
• Rural and urban obstetric service losses differed across states. From 2010 to 2022, more than 40% of rural hospitals lost obstetrics in the states of Pennsylvania, South Carolina, West Virginia and Florida, and more than 25% of urban hospitals lost obstetrics in the states of Kansas, Washington, D.C., Rhode Island, Oklahoma and Hawaii. Declines in care disproportionately affected rural hospitals in highly rural states; in North Dakota, for example, 73% of hospitals lacked obstetrics by 2022, followed by Oklahoma (63%), and West Virginia (62%).
• Obstetric care losses varied widely by state. While states like Delaware, Utah and Vermont experienced no closures during 2010-2022; others — like Iowa, West Virginia and Oklahoma — had more than a quarter of hospitals eliminate obstetric services.

“Access to hospital-based obstetric care is eroding in rural and urban communities across many U.S. states. This is occurring alongside a maternal health crisis and in a rapidly-evolving state health policy environment” said Katy Backes Kozhimannil, Distinguished McKnight University Professor and lead author. “Obstetric unit closures can increase distance to care and put pregnant patients and newborns at risk. Our analysis revealed wide variability across states in obstetric care losses, and highlighted the growing access challenges faced by people living in rural communities and highly rural states”

University of Minnesota co-authors included Dr. Julia Interrante, Dr. Caitlin Carroll, Emily Sheffield and Alyssa Fritz. This analysis was conducted in collaboration with researchers from the University of Pennsylvania (Dr. Sara Handley) and Harvard University (Dr. Alecia McGregor).

This study was supported by the Heinz Family Foundation, the University of Minnesota Foundation Rural Health Research Center Fund, the National Institutes of Health, and the Federal Office of Rural Health Policy, Health Resources and Services Administration. The content is solely the responsibility of the authors and does not represent the official views of the funding entities. The information, conclusions and opinions expressed are those of the authors, and no endorsement by any funder is intended or should be inferred.