Maternal mortality rates in the U.S. are consistently higher than those in many other high-income countries. These rates increase more for people in rural areas and people of color, who experience bigger gaps in health care access and quality. A wave of hospital obstetric unit closures in rural and urban communities are adding to this already dire situation.

A new study published in JAMA led by the University of Minnesota’s School of Public Health examines changes in access to obstetric care in U.S. hospitals. Using the team’s enhanced algorithm, and with data from the American Hospital Association Annual Survey and the Centers for Medicare & Medicaid Services, researchers tracked changes in obstetric status at 4,964 acute-care hospitals, including 1,982 located in rural counties and 2,982 in urban counties.

The study found between 2010 and 2022:

• The percentage of all hospitals without obstetric services rose from 35% to 42%. By 2022, 52% of rural hospitals lacked obstetric services, compared to 36% of urban hospitals.
• Overall, 537 hospitals discontinued obstetric care — 299 in urban areas and 238 in rural communities.
• Only 138 U.S. hospitals added obstetric care, with most gains occurring in urban areas — 112 urban hospitals and 26 rural.

“Maternal mortality is a tragedy for too many families, and the consequences reverberate for generations. Closure of obstetric units and further limiting access to quality health care is only going to make the problem worse,” said Distinguished McKnight University Professor and lead author Katy Kozhimannil. “Rural hospitals not only started with fewer obstetric services but also experienced more severe losses over time, leaving rural residents with fewer options and longer distances to travel — often at times when patients are in urgent need of timely care. Without targeted resources and policy interventions focused on equitable access to maternity care for all, including people of color and geographically-isolated folks, this public health crisis will only get worse.”

Funding support for the study was provided by the Federal Office of Rural Health Policy, part of the Health Resources and Services Administration in the U.S. Department of Health and Human Services.

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