Research Alert: April 17, 2017

Access to Obstetric Services in Rural Communities

This research alert contains two different policy briefs.

Access to obstetric care in rural communities is critical to ensuring good maternal and child health outcomes. Although over 28 million reproductive-age women live in rural U.S. counties, 43% of rural counties in the U.S. had no hospital-based obstetric services in 2002. Media coverage and reports since then have indicated that the number of rural hospitals providing obstetric care has been decreasing; however, the national scope of these access problems has not been quantified.

A recent project by the University of Minnesota Rural Health Research Center has resulted in two policy briefs which examine the closure of hospital-based obstetric services in rural areas from 2004 to 2014: one takes a national perspective, while a second brief documents state-level variability on the same topic.

Closure of Hospital Obstetric Services Disproportionately Affects Less-Populated Counties

Key Findings
Between 2004 and 2014:

  • The percent of all rural counties in the U.S. that lacked hospital obstetric services increased from 45% to 54%, due to hospital and obstetric-unit closures.
  • 179 rural counties (9% of all rural counties) lost access to in-county hospital obstetric services.
  • Women living in rural noncore counties (areas with less than 10,000 residents) were disproportionately affected by the loss of hospital obstetric services.
  • Only 40.2% of rural noncore counties had continual hospital obstetric services compared to 77.9% of micropolitan counties.

State Variability in Access to Hospital-Based Obstetric Services in Rural US Counties

Key Findings
Between 2004 and 2014:

  • County-level access to hospital obstetric (OB) services varied considerably across states.
  • More than two-thirds of rural counties in Florida (78%), Nevada (69%), and South Dakota (66%) had no in-county hospital OB services.
  • Rural counties in South Carolina (25%), Washington (22%), and North Dakota (21%) experienced the greatest decline in hospital OB services.
  • North Dakota (15%), Florida (17%), and Virginia (21%) had the lowest percentage of rural counties with continual hospital OB services owing to loss of hospital OB units in rural noncore areas of North Dakota and Virginia, and in micropolitan areas of Florida.
Contact Information:

Peiyin Hung, MSPH
University of Minnesota Rural Health Research Center

Additional Resources of Interest: