Rural Health
Research Gateway

Research Alert: December 10, 2025

Availability of Higher-Level Neonatal Care Services in Rural U.S. Counties, 2010-2022

Infant mortality is elevated in rural, compared with urban, communities. Neonatal health care includes basic well-infant/level 1 services, available at health care facilities that offer childbirth services, as well as higher-level care (neonatal intermediate and intensive care services, at level II or higher). Access to higher-level neonatal care can be lifesaving for infants with high acuity clinical needs, and access to childbirth-related care has been declining in rural communities. The purpose of this policy brief is to show the changes in the availability of higher-level neonatal care in rural United States (U.S.) counties from 2010 to 2022, and how this availability differs by rural county type (micropolitan vs. noncore).

Key Findings:

  • Researchers examined availability of higher-level neonatal care (intermediate level II or intensive level III or IV care) at short-term acute care hospitals in rural counties of the U.S., including all hospitals not involved in mergers between 2010 and 2022.
  • In the U.S., availability of any higher-level neonatal care declined from 2010-2022 in rural counties. Overall, 7.5% of rural counties (147/1958) had higher-level neonatal care in 2010, and 6.9% of rural counties (136/1958) had this care in 2022. In 2022, 93.1% of rural counties (1822/1958) had no higher-level neonatal care.
  • Among rural counties, researchers distinguished between noncore and micropolitan counties. Among noncore counties, the percentage with higher-level neonatal care declined from 2.1% (27/1300) in 2010 to 1.2% (16/1300) in 2022. In 2010, 18.2% of micropolitan counties (120/658) had higher-level neonatal care, remaining similar in 2022 (18.2%; 120/658).
  • Only about 1% of noncore rural counties had higher-level neonatal care availability in 2022; 20 of the 27 noncore counties that had higher-level neonatal care in 2010 lost this service by 2022.
Contact Information:

Katy Kozhimannil, PhD, MPA
University of Minnesota Rural Health Research Center
Phone: 612.626.3812
kbk@umn.edu

Additional Resources of Interest: