Volume 44 of the Health Affairs Journal has published an article on "Obstetric Care Access Declined in Rural and Urban Hospitals Across US States, 2010-22." The study was authored by Katy Backes Kozhimannil, Julia D. Interrante, Caitlin Carroll, Emily C. Sheffield, Alyssa H. Fritz, Alecia J. McGregor, and Sara C. Handley. The key findings are excerpted below:
[T]his study indicates that obstetric unit closures are continuing, and differences in state policy environments may shape access to obstetric care for pregnant rural and urban residents living in different states.
Declines in hospital-based obstetric services were heterogeneous across states, although declines disproportionately affected rural hospitals in highly rural states, including Alaska, Arkansas, Idaho, Iowa, Montana, New Hampshire, North Dakota, Oklahoma, West Virginia, and Wyoming. Although obstetric unit closures can consolidate care at higher-acuity facilities, the loss of these units can increase distance to care for pregnant patients and eliminate obstetric care access for large geographic areas. Greater distances to care are associated with maternal morbidity and adverse infant outcomes. Impacts of these closures may be particularly acute for rural residents who are also lower income and those who bear higher risks for maternal and infant morbidity and mortality.
States as diverse as Hawaii, Kansas, Oklahoma, Rhode Island, and Washington, D.C., saw more than 25 percent of urban hospitals lose the obstetric service line. In urban settings, people in economically marginalized neighborhoods may be particularly vulnerable to the impact of obstetric unit closures, even if travel times are not dramatically affected.
Access to obstetric care is an important determinant of maternal and infant health outcomes, and in a time of maternal health crisis in the US, hospital-based obstetric services have declined across most states and in both rural and urban communities. These findings could inform state-specific, targeted planning and policy efforts to address declining obstetric care access and associated maternal and infant health outcomes in rural and urban US communities.